2015-08-18 19:26:05

1. Initial Data Load

1.1. Juana Mariana Gonzales Initial Data Load

1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old

1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice

1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice

1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent

1.1.5. Enter Adverse Reaction to the Polio Vaccine

1.1.6. Enter allergy to egg albumin

1.2. Juan Marcel Gonzales Initial Data Load

1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Gonzales

1.2.2. Enter Clinical History for Juan Marcel Gonzales

1.3. Mariela Gonzales Morales Initial Data Load

1.3.1. Enter Initial Demographic Data for Mariela Gonzales Morales

1.3.2. Enter Initial Clinical Information for Mariela

1.4. Juana Maria Gonzales Morales Initial Data Load

1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales Morales

2. Query the Registry

2.1. Query the Registry for Juana Mariana Gonzales

2.1.1. Select Patient Juana Mariana Gonzales

2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales

2.2. Query the Registry for Juan Marcel Gonzales

2.2.1. Select Patient Juan Marcel Gonzales

2.2.2. Query Registry for vaccination history and forecast for Juan Marcel Gonzales

2.3. Query the Registry for Mariela Gonzales Morales

2.3.1. Select Patient Mariela Gonzales Morales

2.3.2. Query Registry for vaccination history and forecast for Mariela Gonzales Morales

2.4. Query the Registry for Juana Maria Gonzales Morales.

2.4.1. Select Patient Juana Maria Gonzales Morales

2.4.2. Query Registry for vaccination history and forecast for Juana Maria Gonzales Morales

3. Display Reconcile Update Immunizations

3.1. Juana Mariana Gonzales Display Reconcile Update Immunization Information

3.1.1. View and Compare response to request for vaccination history for Juana Mariana Gonzales

3.1.2. Mark first MMRV Dose as Invalid

3.1.3. View the vaccination forecast for Juana Mariana Gonzales

3.1.4. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales

3.1.5. View the updated vaccination forecast for Juana Mariana Gonzales

3.2. Juan Marcel Gonzales Display Reconcile Update Immunization Information

3.2.1. View and import response to request for vaccination history for Juan Marcel Gonzales

3.2.2. View the vaccination forecast for Juan Marcel Gonzales returned by the Immunization Registry

3.2.3. View the vaccination forecast for Juan Marcel Gonzales

3.3. Mariela Gonzales Morales Display Reconcile Update Immunization Information

3.3.1. View and import response to request for vaccination history for Mariela Gonzales Morales

3.3.2. View the vaccination forecast for Mariela Gonzales Morales returned by the Immunization Registry

3.3.3. View the vaccination forecast for Mariela Gonzales Morales

3.4. Juana Maria Gonzales Morales Display Reconcile Update Immunization Information

3.4.1. View and import response to request for vaccination history for Juana Maria Gonzales Morales

3.4.2. View the vaccination forecast for Juana Maria Gonzales Morales returned by the Immunization Registry

3.4.3. View the vaccination forecast for Juana Maria Gonzales Morales

4. Order and Immunize patient

4.1. Juana Mariana Gonzales, Enter Orders and Immunizations

4.1.1. Order IPV and view prior reaction

4.1.2. IPV Parental Refusal

4.1.3. Order Influenza vaccine and view allergy alert

4.1.4. Order MMRV Vaccine

4.1.5. Records Influenza Vaccine administration route with data validation checking

4.1.6. Record Influenza Vaccine administration

4.1.7. Records MMRV Vaccine administration route with data validation checking

4.1.8. Record MMRV Vaccine administration

4.2. Juan Marcel Gonzales, Enter Orders and Immunizations

4.2.1. Order intranasal, live virus influenza vaccine and view asthma contraindication

4.2.2. Orders administration of Hepatitis B vaccine

4.2.3. Orders administration of DTaP vaccine and alerted that the dose is too early

4.2.4. Records Hepatitis B Vaccine lot number with expired lot alert

4.2.5. Record Hepatitis B Vaccine administration

4.2.6. Records Influenza Vaccine administration with VFC eligibility checking

4.2.7. Record Influenza Vaccine administration for Juan Marcel Gonzales

4.3. Mariela Gonzales Morales, Enter Orders and Immunizations

4.3.1. Enters a deferral for the vaccines due

5. Transmit Immunization Report

5.1. Juana Mariana Gonzales Transmit Immunization Report

5.1.1. Transmit the immunization report to the Immunization Registry

5.1.2. Record an adverse reaction

5.1.3. Transmit the updated vaccination report with adverse reaction to the registry

5.2. Juan Marcel Gonzales Transmit Immunization Report

5.2.1. Transmit the Immunization Report for Juan Marcel Gonzales

5.3. Mariela Gonzales Morales Transmit Immunization Report

5.3.1. Transmit the Immunization Report for Mariela Gonzales Morales

6. Display Immunization Report

6.1. Juana Mariana Gonzales Display Immunization Report

6.1.1. Produce an immunization report for Juana Mariana Gonzales including all history

6.2. Juan Marcel Gonzales Display Immunization Report

6.2.1. Produce an immunization report for Juan Marcel Gonzales including all history

6.3. Mariana Gonzales Morales Display Immunization Report

6.3.1. Produce an immunization report for Juan Marcel Gonzales including all history

7. Cohort Report

7.1. Overdue Immunizations

7.1.1. Produce Overdue Immunizations Cohort Report

1. Initial Data Load
The initial Data load will consist of the vendor entering data during live interactive testing for 4 patients with various scenarios. The data entry will include demographic data, Immunization histories and specific conditions for each patient.
1.1. Juana Mariana Gonzales Initial Data Load
Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 6-year old Juana Mariana Gonzales. There are no transactions associated with this test case.
Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Gonzales. The data includes immunizations provided by the practice.

The vendor also enters:

? Two vaccines administered at other sites

? ?o an influenza vaccine given at a local pharmacy

? ?o an inactivated polio vaccine given elsewhere and not reported to the registry ? the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

? Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

? Allergy to egg albumin administered at this site (the registry has different CVX date and lot number information for this vaccine)

NOTE: the historical vaccines will be imported during the Registry query ?(e.g. from another practice)

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions ?in the record created for Juana Mariana Gonzales?using the test data provided.

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old
Test Step Type: SUT_MANUAL
Juana Mariana Gonzales is entered as a patient in the EMR, including all pediatric demographic information.
Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Gonzales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”) Vendor supplied Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name Shoreline Pediatrics Y

Patient ID: Type (e.g., medical record number, IIS ID) Vendor supplied Y

Patient Name: First Juana Y

Patient Name: Middle Mariana Y

Patient Name: Last Gonzales Y

Patient Date of Birth 12/23/2009 Y

Birth Time 11:05 N

Patient Gender (Administrative Sex) F Y

Patient Multiple Birth Indicator No Y

Patient Birth Order NA C

Responsible Person Name: First Joanna Y

Responsible Person Name: Middle Merida Y

Responsible Person Name: Last Gonzales Y

Responsible Person Name: Relationship to Patient Grandmother Y

Mother’s Name: First Maria Y

Mother’s Name: Middle Merida Y

Mother’s Name: Last Gonzales Y

Mother’s Name: Maiden Last Acosta Y

Patient Address: Street 4345 Standish Way Y

Patient Address: City Stamford Y

Patient Address: State CT Y

Patient Address: Country USA Y

Patient Address: Zipcode 06903 Y

Patient Address: County of Residence Fairfield N

Race White Y

Ethnicity Hispanic or Latino Y

Birthing Facility Name (Birth Delivery Location Address BDL) Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901 [Y - birthing facility name, not address]

Patient Birth State CT Y

Patient Primary Language English Y

Patient Telephone Number (203) 555-1212 Y

Patient Telephone Number Type (e.g., home, cell) home Y

Patient E-mail Address jmg@gmail.com N

Publicity Code N

Protection Indicator N

Protection Indicator Effective Date N

Immunization Registry Status N

Preferred Contact Method Phone Y

Notes to Testers

No Note

1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice
Test Step Type: SUT_MANUAL
Patient History from the local practice is entered into the EMR.
Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history the known to the local practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Vaccine from Practice HepB

Entered BY Sandra Molina Y

Ordering Provider Frank Smith Y

Entering Organization Shoreline Pediatrics Y

Administration Notes (Vaccine Event information source) New immunization record (NIP001 00) Y

Date/Time of Start of Administration 1/15/2010 Y

Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) Y

Administered Amount (of Vaccine) 0.5 Y

Administered Units (of Measure) mL Y

Administering Provider Sandra Molina Y

Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y

Lot Number 6352FK1 Y

Substance Expiration Date 10/1/2010 Y

Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB) Y

Completion Status CP Y

Route of Administration IM Y

Administration Site Right Thigh Y

Vaccine from Practice MMRV

a. Entered BY J. Martinez Y

b. Ordering Provider Frank Smith Y

c. Entering Organization Shoreline Pediatrics Y

Vaccine Event information source New immunization record (NIP001 00) Y

Value/Text for Vaccine Type MMRV Y

Date/Time of Start of Administration 10/23/2010 Y

Vaccine Administered measles, mumps, rubella, and varicella virus vaccine Y

Administered Amount (of Vaccine) 0.5 Y

Administered Units (of Measure) mL Y

Administering Provider

Sandra Molina Y

Administered-at Location

400 Shoreline Drive, Stamford Connecticut 06901

Y

Lot Number 7W27V7491 Y

Substance Expiration Date 12/15/2010 Y

Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD) Y

Completion Status CP Y

Route of Administration Intramuscular (NCIT IM) Y

Administration Site Right Thigh (HL70163 RT)

Notes to Testers

No Note

1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice
Test Step Type: SUT_MANUAL
Patient History from another practice is entered into the EMR.
Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from another practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - Dtap

Entered BY Sandra Molina Y

Ordering Provider J. Rodriguez Y

Entering Organization Shoreline Pediatrics Y

Vaccine Event information source (Administration Notes) Historical information - from parent’s written record (NIP001 03) Y

Value/Text for Vaccine Type DTaP Y

Date/Time of Start of Administration 8/31/2014 Y

Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) Y

Administered Amount (of Vaccine) 0.5 Y

Administered Units (of Measure) mL Y

Administering Provider Linda Casera Y

Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y

Lot Number D643QS8243 Y

Substance Expiration Date 9/1/2014 Y

Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y

Completion Status CP Y

Route of Administration Intramuscular (NCIT IM) Y

Administration Site Left Deltoid (HL70163 LD) Y

Historical Vaccine from Another Practice - Polio

Entered BY Sandra Molina Y

Ordering Provider J. Rodriguez Y

Entering Organization Shoreline Pediatrics Y

Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y

Value/Text for Vaccine Type

poliovirus vaccine, inactivated (CVX 10)

Y

Date/Time of Start of Administration 2/21/2011 Y

Vaccine Administered poliovirus vaccine, inactivated (CVX 10) Y

Administered Amount (of Vaccine) 0.5 Y

Administered Units (of Measure) mL Y

Administering Provider Linda Casera Y

Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y

Lot Number D335PV9644 Y

Substance Expiration Date 2/22/2011 Y

Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y

Completion Status CP Y

Route of Administration Intramuscular (NCIT IM) Y

Administration Site Left Deltoid (HL70163 LD) Y

Reaction VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS Y

Notes to Testers

No Note

1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent
Test Step Type: SUT_MANUAL
Patient History from a pharmacy as reported by the parent is entered into the EMR.
Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic data in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent

Entered BY Sandra Molina Y

Ordering Provider Gina Ricci Y

Entering Organization Shoreline Pediatrics Y

Vaccine Event information source (Administration Notes) Historical information - from other provider (NIP001 02) Y

Value/Text for Vaccine Type Influenza vaccine Y

Date/Time of Start of Administration 10/15/2013 Y

Vaccine Administered influenza, live, intranasal, quadrivalent (CVX 149) FluMist Quadrivalent (NDC 66019-0301-10)) Y

Administered Amount (of Vaccine) 0.5 Y

Administered Units (of Measure) mL Y

Administering Provider Gina Ricci Y

Administered-at Location Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901 Y

Lot Number 8L4B3423 Y

Substance Expiration Date 7/1/2014 Y

Substance Manufacturer Name MedImmune, LLC (MVX MED) Y

Completion Status CP Y

Route of Administration Nasal (NCIT NS) Y

Administration Site Y

Notes to Testers

No Note

1.1.5. Enter Adverse Reaction to the Polio Vaccine
Test Step Type: SUT_MANUAL
The EHR captures structured data regarding adverse events as part of the clinical history.
Test Story

Description

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Gonzales.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

Adverse Reaction Substance/Agent inactivated polio vaccine (e.g. Poliomyelitis vaccine adverse reaction (disorder) 293117006) Y

Reaction febrile seizure (e.g. Simple febrile seizure (finding) 432354000)
VXC11^convulsions (fits, seizures) within 72 hours of dose^ Y

Date (of the reaction) 8/31/2014 Y

Notes to Testers

No Note

1.1.6. Enter allergy to egg albumin
Test Step Type: SUT_MANUAL
The EHR captures structured data regarding allergies as part of the clinical history.
Test Story

Description

The provider documents in the EMR the clinical history of an allergy to egg albumin.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the allergy to egg albumin is documented in the record created for Juana Mariana Gonzales

Test Objectives

Supporting data for: Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical allergy data provided with all required attributes indicated by [Y]:

Allergy Sugstance/Agent Egg Albumin Allergy (e.g. 213020009 Egg protein allergy (disorder), Allergy to eggs (disorder) 91930004) Y

Date (allergy status known - e.g. thru testing or date of the allergy) 8/31/2014 Y

Notes to Testers

No Note

1.2. Juan Marcel Gonzales Initial Data Load
Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 3 1/2-year old Juan Marcel Gonzales. There are no transactions associated with this test case.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Gonzales
Test Step Type: SUT_MANUAL
Juan Marcel Gonzales is entered as a patient in the EMR, including all pediatric demographic information.
Test Story

Description

The EHR vendor loads demographic data for Juan Marcel Gonzales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic in the record created for Juan Marcel Gonzales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Juan

Y

Patient Name: Middle

Marcel

Y

Patient Name: Last

Gonzales

Y

Patient Date of Birth

NA

Y

Birth Time

NA

N

Patient Gender (Administrative Sex)

NA

Y

Patient Multiple Birth Indicator

11/23/2011 11am

Y

Patient Birth Order

M

C

Responsible Person Name: First

Manuel

Y

Responsible Person Name: Middle

Marcel

Y

Responsible Person Name: Last

Gonzales

Y

Responsible Person Name: Relationship to Patient

Father

Y

Mother’s Name: First

Anita

Y

Mother’s Name: Middle

Francesca

Y

Mother’s Name: Last

Gonzales

Y

Mother’s Name: Maiden Last

Morales

Y

Patient Address: Street

4623 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901

[Y – birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1213

Y

Patient Telephone Number Type (e.g., home, cell)

Home

Y

Patient E-mail Address

None

N

Publicity Code

N

Protection Indicator

N

Protection Indicator Effective Date

N

Immunization Registry Status

N

Preferred Contact Method

Phone

Notes to Testers

No Note

1.2.2. Enter Clinical History for Juan Marcel Gonzales
Test Step Type: SUT_MANUAL
The EHR captures structured data regarding a problem of Asthma as part of the clinical history.
Test Story

Description

The clinical history of Moderate Persistent Asthma is documented in the record created for Juan Marcel Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juan Marcel Gonzales.

PostCondition

The clinical history of the Moderate Persistent Asthma is documented in the record created for Juan Marcel Gonzales.

Test Objectives

Supporting data for testing contraindications.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical history data provided with all required attributes indicated by [Y]:

Adverse History of Asthma

Problems Moderate Persistent Asthma (e.g. Moderate persistent asthma – SNOMED-CT 427295004) Y Coded value expected using SNOMED-CT or ICD

Notes to Testers

No Note

1.3. Mariela Gonzales Morales Initial Data Load
Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Mariela Gonzales Morales. There are no transactions associated with this test case.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

1.3.1. Enter Initial Demographic Data for Mariela Gonzales Morales
Test Step Type: SUT_MANUAL
Mariela Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.
Test Story

Description

The EHR vendor loads demographic data for Mariela Gonzales Morales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic in the record created for Mariela Gonzales Morales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Mariela

Y

Patient Name: Middle

Gonzales

Y

Patient Name: Last

Morales

Y

Patient Date of Birth

5/30/2015

Y

Birth Time

11am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

1

C

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Morales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother’s Name: First

Joanna

Y

Mother’s Name: Middle

Elena

Y

Mother’s Name: Last

Morales

Y

Mother’s Name: Maiden Last

Gonzales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y – birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

N

Protection Indicator

N

Protection Indicator Effective Date

N

Immunization Registry Status

N

Preferred Contact Method

none

Notes to Testers

No Note

1.3.2. Enter Initial Clinical Information for Mariela
Test Step Type:
The EHR captures structured data indicating that Mariela has a fever in the current visit.
Test Story

Description

The triage nurse enters basic information on Mariela Gonzales Morales – she has a fever (Temperature of 100.8o F).

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Mariela Gonzales Morales.

PostCondition

The clinical record for Mariela Gonzales Morales indicates that she currently has a fever (temperature 100.8oF)..

Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule): Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s current or historical diagnoses.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical data provided with all required attributes indicated by [Y]:

Vital Signs Fever of 100.1 (@code LOINC 8310-5 @value 100.1)

Vital Signs Observation Date Date of current visit

Problems (If vendor uses problems for alert computations, then this should be included.) Problem list: ( Low grade pyrexia (finding) 304213008)

Problem Observation Date Date of current visit

Notes to Testers

No Note

1.4. Juana Maria Gonzales Morales Initial Data Load
Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Maria Gonzales Morales. There are no transactions associated with this test case.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales Morales
Test Step Type: SUT_MANUAL
Juana Maria Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.
Test Story

Description

The EHR vendor loads demographic data for Juana Maria Gonzales Morales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Maria Gonzales Morales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First

Juana

Y

Patient Name: Middle

Maria Gonzales

Y

Patient Name: Last

Morales

Y

Patient Date of Birth

5/30/2015

Y

Birth Time

11:15am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

2

C

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Morales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother’s Name: First

Joanna

Y

Mother’s Name: Middle

Elena

Y

Mother’s Name: Last

Morales

Y

Mother’s Name: Maiden Last

Gonzales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y – birthing

facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

N

Protection Indicator

N

Protection Indicator Effective Date

N

Immunization Registry Status

N

Preferred Contact Method

none

]

Notes to Testers

No Note

2. Query the Registry
Querying the registry will consist of the vendor creating Z44 messages for each patient to be sent to the registry. The response will be processed as part of the ?Display, Reconcile, Import and Update Immunization Information? activity.
2.1. Query the Registry for Juana Mariana Gonzales
EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Gonzales.
Test Story

Description

Query the Registry for Juana Mariana Gonzales

Comments

No Comments

PreCondition

Juana Mariana Gonzales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Gonzales Initial Data Load'

PostCondition

A Z44 Query is generated and submitted to the Immunization Registry/Test tool.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry ?on demand? (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother?s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) ? HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

The vendor can produce a valid Z44 query in accordance with the test data correctly and without ommission.
The data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

2.1.1. Select Patient Juana Mariana Gonzales
Test Step Type:
Select patient Juana Mariana Gonzales, distinguishing the patient from other patients with similar demographics (similar names).
Test Story

Description

Juana Mariana Gonzales is selected as the patient and her record is opened in the EMR.

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load completed.

PostCondition

Juana Mariana Gonzales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Gonzales from similar sounding names using all of the pediatric demographics:

Patient ID (previously listed as “Medicaid Number”) - Vendor supplied

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics

Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied

Patient Name: First - Juana

Patient Name: Middle - Mariana

Patient Date of Birth - 12/23/2009

Birth Time - 11:05

Patient Gender (Administrative Sex) - F

Patient Multiple Birth Indicator - No

Patient Birth Order - NA

Responsible Person Name: First - Joanna

Responsible Person Name: Middle - Merida

Responsible Person Name: Last - Gonzales

Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent)

Mother’s Name: First - Maria

Mother’s Name: Middle -Merida

Mother’s Name: Last - Gonzales

Mother’s Name: Maiden Last - Acosta

Patient Address: Street - 4345 Standish Way

Patient Address: City - Stamford

Patient Address: State - CT

Patient Address: Country - US

Patient Address: Zipcode - 06903

Patient Address: County of Residence - Fairfield

Race - White

Ethnicity - Hispanic or Latino

Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901

Patient Birth State - CT

Patient Primary Language - English

Patient Telephone Number - (203) 555-1212

Patient Telephone Number Type (e.g., home, cell) - home

Patient E-mail Address - jmg@gmail.com

Publicity Code

Protection Indicator

Protection Indicator Effective Date

Immunization Registry Status

Preferred Contact Method - Phone

Notes to Testers

No Note

2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales
Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.
Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20150615001020-0500

MSH.9 Message Type

MSH.9.1 Message Code QBP

MSH.9.2 Trigger Event Q11

MSH.9.3 Message Structure QBP_Q11

MSH.10 Message Control ID 793543

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z44

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number 123456

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID MYEHR

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code MR

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales Test Case Fixed

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana Test Case Fixed

QPD.4.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed

QPD.4.7 Name Type Code L Test Case Fixed

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Acosta Test Case Fixed

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M Test Case Fixed

QPD.6 PatientDateOfBirth

QPD.6.1 Time 200911231105 Test Case Fixed

QPD.7 Patient Sex F Test Case Fixed

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 4345 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation Test Case Fixed

QPD.8.3 City Stamford Test Case Fixed

QPD.8.4 State or Province CT Test Case Fixed

QPD.8.5 Zip or Postal Code 06903 Test Case Fixed

QPD.8.6 Country

QPD.8.7 Address Type L Test Case Fixed

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN Test Case Fixed

QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203 Test Case Fixed

QPD.9.7 Local Number 5551212 Test Case Fixed

QPD.10 Multiple birth indicator

QPD.11 Birth order

RCP : Response Control Parameter

Location Data Element Data Categorization

RCP.1 Query Priority I

Test Data Specification

Patient Information

Element Data

Patient Name Juana Mariana Gonzales

Date/Time of Birth 11/23/2009

Sex Female

Patient Address 4345 Standish Way Stamford CT

Patient Phone (203)555-1212

2.2. Query the Registry for Juan Marcel Gonzales
EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juan Marcel Gonzales.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

2.2.1. Select Patient Juan Marcel Gonzales
Test Step Type: SUT_MANUAL
Select patient Juan Marcel Gonzales, distinguishing the patient from other patients with similar demographics (similar names).
Test Story

Description

Juan Marcel Gonzales is selected as the patient and his record is opened in the EMR.

Comments

No Comments

PreCondition

Juan Marcel Gonzales Initial Data Load completed.

PostCondition

Juan Marcel Gonzales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juan Marcel Gonzales from similar sounding names using all of the pediatric demographics:

Patient ID (previously listed as “Medicaid Number”) - Vendor supplied

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics

Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied

Patient Name: First - Juan

Patient Name: Middle - Marcel

Patient Name: Last - Gonzales

Patient Date of Birth - 11/23/2011

Birth Time - 11:00

Patient Gender (Administrative Sex) -  M

Patient Multiple Birth Indicator - No

Patient Birth Order - NA

Responsible Person Name: First - Manuel

Responsible Person Name: Middle - Marcel

Responsible Person Name: Last - Gonzales

Responsible Person Name: Relationship to Patient - Father

Mother’s Name: First - Anita

Mother’s Name: Middle - Francesca

Mother’s Name: Last - Gonzales

Mother’s Name: Maiden Last - Morales

Patient Address: Street - 4623 Standish Way

Patient Address: City - Stamford

Patient Address: State - CT

Patient Address: Country - US

Patient Address: Zipcode - 06903

Patient Address: County of Residence - Fairfield

Race - White

Ethnicity - Hispanic or Latino

Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901

Patient Birth State - CT

Patient Primary Language - English

Patient Telephone Number - (203) 555-1213

Patient Telephone Number Type (e.g., home, cell) - home

Patient E-mail Address -

Publicity Code

Protection Indicator

Protection Indicator Effective Date

Immunization Registry Status

Preferred Contact Method - Phone

Notes to Testers

No Note

2.2.2. Query Registry for vaccination history and forecast for Juan Marcel Gonzales
Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.
Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juan Marcel Gonzales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juan Marcel Gonzales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20140515001020-0500

MSH.9 Message Type

MSH.9.1 Message Code QBP

MSH.9.2 Trigger Event Q11

MSH.9.3 Message Structure QBP_Q11

MSH.10 Message Control ID 793543

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z44

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number 123456

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID MYEHR

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code MR

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales Test Case Fixed

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juan Test Case Fixed

QPD.4.3 Second and Further Given Names or Initials Thereof Marcel Test Case Fixed

QPD.4.7 Name Type Code L Test Case Fixed

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Morales Test Case Fixed

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M Test Case Fixed

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201111231100 Test Case Fixed

QPD.7 Patient Sex M Test Case Fixed

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 4623 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation Test Case Fixed

QPD.8.3 City Stamford Test Case Fixed

QPD.8.4 State or Province CT Test Case Fixed

QPD.8.5 Zip or Postal Code 06903 Test Case Fixed

QPD.8.6 Country

QPD.8.7 Address Type L Test Case Fixed

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN Test Case Fixed

QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203 Test Case Fixed

QPD.9.7 Local Number 5551213 Test Case Fixed

QPD.10 Multiple birth indicator

QPD.11 Birth order

RCP : Response Control Parameter

Location Data Element Data Categorization

RCP.1 Query Priority I

Test Data Specification

Patient Information

Element Data

Patient Name Juan Marcel Gonzales

Date/Time of Birth 11/23/2011

Sex Male

Patient Address 4623 Standish Way Stamford CT

Patient Phone (203)555-1213

2.3. Query the Registry for Mariela Gonzales Morales
EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Mariela Gonzales Morales.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

2.3.1. Select Patient Mariela Gonzales Morales
Test Step Type: SUT_MANUAL
Select patient Mariela Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).
Test Story

Description

Mariela Gonzales Morales is selected as the patient and her record is opened in the EMR.

Comments

No Comments

PreCondition

Mariela Gonzales Morales Initial Data Load completed.

PostCondition

Mariela Gonzales Morales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Mariela Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

Patient ID (previously listed as “Medicaid Number”) - Vendor supplied

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics

Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied

Patient Name: First - Mariela

Patient Name: Middle - Gonzales

Patient Name: Last - Morales

Patient Date of Birth - 05/30/2015

Birth Time - 11:00

Patient Gender (Administrative Sex) -  F

Patient Multiple Birth Indicator - Yes

Patient Birth Order - 1

Responsible Person Name: First - Joanna

Responsible Person Name: Middle - Gonzales

Responsible Person Name: Last - Morales

Responsible Person Name: Relationship to Patient - Mother

Mother’s Name: First - Joanna

Mother’s Name: Middle - Gonzales

Mother’s Name: Last - Morales

Mother’s Name: Maiden Last - Gonzales

Patient Address: Street - 3321 Standish Way

Patient Address: City - Stamford

Patient Address: State - CT

Patient Address: Country - US

Patient Address: Zipcode - 06903

Patient Address: County of Residence - Fairfield

Race - White

Ethnicity - Hispanic or Latino

Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903

Patient Birth State - CT

Patient Primary Language - English

Patient Telephone Number - (203) 555-1214

Patient Telephone Number Type (e.g., home, cell) - home

Patient E-mail Address -

Publicity Code

Protection Indicator

Protection Indicator Effective Date

Immunization Registry Status

Preferred Contact Method - Phone

Notes to Testers

No Note

2.3.2. Query Registry for vaccination history and forecast for Mariela Gonzales Morales
Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.
Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Mariela Gonzales Morales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Mariela Gonzales Morales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20140515001020-0500

MSH.9 Message Type

MSH.9.1 Message Code QBP

MSH.9.2 Trigger Event Q11

MSH.9.3 Message Structure QBP_Q11

MSH.10 Message Control ID 793543

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z44

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number 123456

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID MYEHR

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code MR

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Morales Test Case Fixed

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Mariela Test Case Fixed

QPD.4.3 Second and Further Given Names or Initials Thereof Gonzales Test Case Fixed

QPD.4.7 Name Type Code L Test Case Fixed

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Gonzales Test Case Fixed

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M Test Case Fixed

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201505301115 Test Case Fixed

QPD.7 Patient Sex F Test Case Fixed

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation Test Case Fixed

QPD.8.3 City Stamford Test Case Fixed

QPD.8.4 State or Province CT Test Case Fixed

QPD.8.5 Zip or Postal Code 06903 Test Case Fixed

QPD.8.6 Country

QPD.8.7 Address Type L Test Case Fixed

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN Test Case Fixed

QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203 Test Case Fixed

QPD.9.7 Local Number 5551214 Test Case Fixed

QPD.10 Multiple birth indicator 1 Test Case Fixed

QPD.11 Birth order 1 Test Case Fixed

RCP : Response Control Parameter

Location Data Element Data Categorization

RCP.1 Query Priority I

Test Data Specification

Patient Information

Element Data

Patient Name Mariela Gonzales Morales

Date/Time of Birth 05/30/2015

Sex Female

Patient Address 3321 Standish Way Stamford CT

Patient Phone (203)555-1214

2.4. Query the Registry for Juana Maria Gonzales Morales.
EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales Morales
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

2.4.1. Select Patient Juana Maria Gonzales Morales
Test Step Type: SUT_MANUAL
Select patient Juana Maria Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).
Test Story

Description

Juana Maria Gonzales Morales is selected as the patient and her record is opened in the EMR.

Comments

No Comments

PreCondition

Juana Maria Gonzales Morales Initial Data Load completed.

PostCondition

Juana Maria Gonzales Morales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information. For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juana Maria Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

Patient ID (previously listed as “Medicaid Number”) - Vendor supplied

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics

Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied

Patient Name: First - Juana

Patient Name: Middle - Maria Gonzales

Patient Name: Last - Morales

Patient Date of Birth - 05/30/2015

Birth Time - 11:15

Patient Gender (Administrative Sex) -  F

Patient Multiple Birth Indicator - Yes

Patient Birth Order - 2

Responsible Person Name: First - Joanna

Responsible Person Name: Middle - Gonzales

Responsible Person Name: Last - Morales

Responsible Person Name: Relationship to Patient - Mother

Mother’s Name: First - Joanna

Mother’s Name: Middle - Gonzales

Mother’s Name: Last - Morales

Mother’s Name: Maiden Last - Gonzales

Patient Address: Street - 3321 Standish Way

Patient Address: City - Stamford

Patient Address: State - CT

Patient Address: Country - US

Patient Address: Zipcode - 06903

Patient Address: County of Residence - Fairfield

Race - White

Ethnicity - Hispanic or Latino

Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903

Patient Birth State - CT

Patient Primary Language - English

Patient Telephone Number - (203) 555-1214

Patient Telephone Number Type (e.g., home, cell) - home

Patient E-mail Address -

Publicity Code

Protection Indicator

Protection Indicator Effective Date

Immunization Registry Status

Preferred Contact Method - Phone

Notes to Testers

No Note

2.4.2. Query Registry for vaccination history and forecast for Juana Maria Gonzales Morales
Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without ommission according to supplied test data
Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juana Maria Gonzales Morales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales Morales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20140515001020-0500

MSH.9 Message Type

MSH.9.1 Message Code QBP

MSH.9.2 Trigger Event Q11

MSH.9.3 Message Structure QBP_Q11

MSH.10 Message Control ID 793543

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z44

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number 123456

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID MYEHR

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code MR

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Morales Test Case Fixed

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana Test Case Fixed

QPD.4.3 Second and Further Given Names or Initials Thereof Maria Gonzales Test Case Fixed

QPD.4.7 Name Type Code L Test Case Fixed

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Gonzales Test Case Fixed

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M Test Case Fixed

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201505301115 Test Case Fixed

QPD.7 Patient Sex F Test Case Fixed

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation Test Case Fixed

QPD.8.3 City Stamford Test Case Fixed

QPD.8.4 State or Province CT Test Case Fixed

QPD.8.5 Zip or Postal Code 06903 Test Case Fixed

QPD.8.6 Country

QPD.8.7 Address Type L Test Case Fixed

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN Test Case Fixed

QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203 Test Case Fixed

QPD.9.7 Local Number 5551214 Test Case Fixed

QPD.10 Multiple birth indicator 1 Test Case Fixed

QPD.11 Birth order 2 Test Case Fixed

RCP : Response Control Parameter

Location Data Element Data Categorization

RCP.1 Query Priority I

Test Data Specification

Patient Information

Element Data

Patient Name Juana Maria Gonzales Morales

Date/Time of Birth 05/30/2015

Sex Female

Patient Address 3321 Standish Way Stamford CT

Patient Phone (203)555-1214

3. Display Reconcile Update Immunizations
The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.
3.1. Juana Mariana Gonzales Display Reconcile Update Immunization Information
Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

3.1.1. View and Compare response to request for vaccination history for Juana Mariana Gonzales
Test Step Type:
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and compare to those in the EMR.
Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

The physician accesses the record for Juana Mariana Gonzales and:

• Reconciles the EHR vaccine history with the history retrieved from the registry:

o Accepts new vaccines from the registry data

o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)

o Retains the local history for influenza and polio vaccines that are not included in the registry report.

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information.

Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana

QPD.4.3 Second and Further Given Names or Initials Thereof Mariana

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Acosta

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M

QPD.6 PatientDateOfBirth

QPD.6.1 Time 200912231105

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 4345 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551212

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juana

PID.5.3 Second and Further Given Names or Initials Thereof Mariana

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 200911231105

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100115

RXA.5 Administered Code

RXA.5.1 Identifier 45

RXA.5.2 Text hepatitis B vaccine, unspecified formulation

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101030

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 107

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100221

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100121

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100925

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101027

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111002

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount .25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120404

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120523

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101023

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 5

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 6

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 7

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 8

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 9

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 10

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 11

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 12

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 13

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 14

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 15

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 16

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100122

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 17

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 18

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 19

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 20

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100323

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100323

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 21

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 31044-1

OBX.3.2 Text Reaction

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100523

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100522

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 26

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 27

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 28

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 29

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20110221

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20110221

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 30

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 31

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 32

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 33

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 34

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 35

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 36

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 37

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 38

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 39

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 40

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 41

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 42

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 43

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 44

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 45

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 46

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 47

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 48

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 49

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 50

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 51

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 52

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 53

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 54

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 55

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 56

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 57

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 58

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 59

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 60

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 61

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 62

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 63

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 64

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 65

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 67

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 68

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 69

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 70

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 71

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 72

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 73

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 78

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 79

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 80

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 81

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 82

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 83

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 84

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 85

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 86

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 87

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 88

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 89

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 90

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 91

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 92

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 93

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20111025

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20111123

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20111123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 94

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 95

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20111025

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20120523

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20120523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 98

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 99

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value N

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 101

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30982-3

OBX.3.2 Text Reason code

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20101023

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20101023

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 102

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 103

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 104

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 105

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20121122

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20121122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20110522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20110523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150901

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150901

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160131

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juana Mariana Gonzales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Juana Mariana Gonzales 11/23/2009 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment

Hep B Peds NOS hepatitis B vaccine, pediatric or pediatric/adolescent dosage 11/23/2009 YES Complete

Hep B Peds NOS hepatitis B vaccine, unspecified formulation 01/15/2010 YES Complete

Hep B Peds NOS hepatitis B vaccine, pediatric or pediatric/adolescent dosage 10/30/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified 01/22/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 03/23/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 05/22/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 02/21/2011 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 01/22/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 03/23/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 05/22/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 02/21/2010 YES Complete

poliovirus vaccine, inactivated poliovirus vaccine, inactivated 01/22/2010 YES Complete

poliovirus vaccine, inactivated poliovirus vaccine, inactivated 03/23/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 01/21/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 03/23/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 05/22/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 02/21/2011 YES Complete

rotavirus, unspecified formulation rotavirus, live, monovalent vaccine 01/22/2010 YES Complete

rotavirus, unspecified formulation rotavirus, live, monovalent vaccine 03/23/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 09/25/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 10/27/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 10/02/2011 Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 04/04/2012 Complete

Hep A, unspecified formulation hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule 11/23/2011 Complete

Hep A, unspecified formulation hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule 05/23/2012 Complete

MMRV measles, mumps, rubella, and varicella virus vaccine 10/23/2010 NO Early Complete

MMRV measles, mumps, rubella, and varicella virus vaccine 11/22/2012 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

IPV 05/22/2010 05/22/2010 05/22/2011

IPV 11/22/2013 11/22/2013 11/22/2015

influenza, unspecified formulation 09/01/2015 09/01/2015 01/31/2016

MMR 11/22/2013 11/22/2013 11/22/2015

Varicella 11/22/2013 11/22/2013 11/22/2015

3.1.2. Mark first MMRV Dose as Invalid
Test Step Type: null
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is ?invalid? as it was given too early (as notified by the registry).
Test Story

Description

If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)

Comments

If the EMR already recognizes the dose as invalid, then this step may be skipped.

PreCondition

MMRV status indicates that the first MMRV dose is valid.

PostCondition

MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid.

Test Objectives

dose validity is an important aspect of:

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early

Notes to Testers

No Note

3.1.3. View the vaccination forecast for Juana Mariana Gonzales
Test Step Type:
Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).
Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them)

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana

QPD.4.3 Second and Further Given Names or Initials Thereof Mariana

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Acosta

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M

QPD.6 PatientDateOfBirth

QPD.6.1 Time 200912231105

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 4345 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551212

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juana

PID.5.3 Second and Further Given Names or Initials Thereof Mariana

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 200911231105

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100115

RXA.5 Administered Code

RXA.5.1 Identifier 45

RXA.5.2 Text hepatitis B vaccine, unspecified formulation

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101030

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 107

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100121

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100925

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101027

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111002

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount .25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121104

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120523

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101023

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text new immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091031

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 5

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 6

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 7

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 8

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 9

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 10

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 11

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 12

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 13

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 14

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 15

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 16

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100122

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 17

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 18

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 19

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 20

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100323

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100323

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 21

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 31044-1

OBX.3.2 Text Reaction

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100523

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100522

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 26

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 27

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 28

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 29

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20070517

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20110221

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20110221

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 30

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 31

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 32

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 33

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 34

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 35

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 36

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 37

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 38

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 39

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 40

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 41

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 42

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 43

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 44

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 45

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 46

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 47

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 48

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 49

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 50

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 51

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 52

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 53

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 54

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 55

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 56

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 57

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 58

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 59

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 60

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 61

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 62

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 63

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 64

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 65

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 67

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 68

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 69

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 70

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 71

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 72

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 73

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 78

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 79

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 80

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 81

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 82

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 83

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 84

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 85

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 86

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 87

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 88

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 89

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 90

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 91

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 92

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 93

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20111025

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20111123

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20111123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 94

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 95

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20111025

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20120523

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20120523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 98

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 99

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value N

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 101

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30982-3

OBX.3.2 Text Reason code

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20101023

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20101023

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 102

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 103

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 104

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 105

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20121122

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS presented

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 20121122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 69764-9

OBX.3.2 Text Document type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F<

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20100522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20110522

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20110523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150901

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150901

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160131

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20131122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151123

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juana Mariana Gonzales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Juana Mariana Gonzales 11/23/2009 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment

Hep B Peds NOS hepatitis B vaccine, pediatric or pediatric/adolescent dosage 11/23/2009 YES Complete

Hep B Peds NOS hepatitis B vaccine, unspecified formulation 01/15/2010 YES Complete

Hep B Peds NOS hepatitis B vaccine, pediatric or pediatric/adolescent dosage 10/30/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified 01/22/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 03/23/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 05/22/2010 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis 02/21/2011 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 01/22/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 03/23/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 05/22/2010 YES Complete

Hib, unspecified formulation Haemophilus influenzae type b vaccine, PRP-OMP conjugate 02/21/2011 YES Complete

poliovirus vaccine, inactivated poliovirus vaccine, inactivated 01/22/2010 YES Complete

poliovirus vaccine, inactivated poliovirus vaccine, inactivated 03/23/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 01/21/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 03/23/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 05/22/2010 YES Complete

pneumococcal, unspecified formulation pneumococcal conjugate vaccine, 13 valent 02/21/2011 YES Complete

rotavirus, unspecified formulation rotavirus, live, monovalent vaccine 01/22/2010 YES Complete

rotavirus, unspecified formulation rotavirus, live, monovalent vaccine 01/22/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 09/25/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 10/27/2010 YES Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 10/02/2011 Complete

influenza, unspecified formulation Influenza, injectable,quadrivalent, preservative free, pediatric 11/04/2012 Complete

Hep A, unspecified formulation hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule 11/23/2011 Complete

Hep A, unspecified formulation hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule 05/23/2012 Complete

MMRV measles, mumps, rubella, and varicella virus vaccine 10/23/2010 NO Early Complete

MMRV measles, mumps, rubella, and varicella virus vaccine 11/22/2012 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

IPV 05/22/2010 05/22/2010 05/22/2011

IPV 11/22/2013 11/22/2013 11/22/2015

influenza, unspecified formulation 09/01/2015 09/01/2015 01/31/2016

MMR 11/22/2013 11/22/2013 11/22/2015

Varicella 11/22/2013 11/22/2013 11/22/2015

3.1.4. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales
Test Step Type:
The Provider uses the EMR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system, and reconcile (import/update) records.
Test Story

Description

Juana Maria Gonzales Morales immunization registry provided Evaluated History and Forecast is reconciled with the Immunization history information in the EMR.

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The user imports returned vaccinations as follows:

a. Vaccinations NOT imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 1/15/2010

measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012

VERIFY that the dose validity is marked as invalid

b. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 12/23/2009

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 10/30/2010

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,

Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011

poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010

poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011

rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012

hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011

hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012

measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012

Notes to Testers

No Note

3.1.5. View the updated vaccination forecast for Juana Mariana Gonzales
Test Step Type: null
Using the reconciled vaccine history information, the EMR displays the current Immunization Forecast to the user for Juana Mariana Gonzales.
Test Story

Description

Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated.

Comments

No Comments

PreCondition

EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales').

PostCondition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user.

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

1. Verify that the EMR does not include in reconciled vaccine forecast:

IPV due on 5/22/2010

2. Verify that the EMR includes in reconciled vaccine forecast:

IPV due on 11/22/2013

MMR due on 5/22/2011

Varicella due on 5/22/2011

influenza, unspecified formulation due on 10/21/2015

Notes to Testers

No Note

3.2. Juan Marcel Gonzales Display Reconcile Update Immunization Information
Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

3.2.1. View and import response to request for vaccination history for Juan Marcel Gonzales
Test Step Type:
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR
Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded

• Views the registry history including the second dose of Hepatitis B vaccine given late (at 2 years of age) and no history of a third dose; influenza vaccine was also not given since 2013

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Gonzales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.
2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 11/23/2011

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 12/23/2013
Verify that the EMR is alerted that this dose was given too late
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2012

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/22/2012

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/21/2012

diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/20/2013

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2012

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/22/2012

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/21/2012

Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/22/2012

poliovirus vaccine, inactivated (CVX 10) administered 1/22/2012

poliovirus vaccine, inactivated (CVX 10) administered 3/22/2012

poliovirus vaccine, inactivated (CVX 10) administered 5/21/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2012

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/22/2012

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/21/2012

pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 11/22/2012

rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2012

rotavirus, live, monovalent vaccine (CVX 119) administered 3/22/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/22/2012

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/20/2012

Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/30/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/21/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 12/1/2013

measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juan

QPD.4.3 Second and Further Given Names or Initials Thereof Marcel

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Morales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code L

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201111231100

QPD.7 Patient Sex M

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551213

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juan

PID.5.3 Second and Further Given Names or Initials Thereof Marcel

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 201111231100

PID.8 Administrative Sex M

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4623 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111223

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130220

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120512

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120222

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 1.0

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 1.0

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120922

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121022

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131030

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130521

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131201

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130112

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text MMR and Varicella

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Thigh Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 5

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 6

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 7

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 8

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 13

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 14

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 15

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 16

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 17

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 18

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 19

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 20

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 5

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 5

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 6

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 6

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 30

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 31

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 32

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 7

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 33

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 7

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 34

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 35

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 36

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 8

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 37

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 8

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 38

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 39

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 40

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 41

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 42

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 43

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 44

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 10

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 45

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 10

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 46

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text poliovirus vaccine, inactivated

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 47

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 48

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 11

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 49

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 11

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 50

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text poliovirus vaccine, inactivated

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 51

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 52

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 12

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 53

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 12

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 54

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 55

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 56

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 57

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 58

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 59

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 60

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 14

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 61

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 14

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 62

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 63

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 64

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 15

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 65

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 15

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 67

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 68

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 16

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 69

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 16

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 71

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 72

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 73

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 18

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 18

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 19

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 19

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 78

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 79

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 80

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 81

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 82

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 83

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 84

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 85

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 86

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 87

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 90

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 91

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 92

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 93

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 94

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 95

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 22

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 22

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 98

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 94

OBX.5.2 Text MMRV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 99

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 45

OBX.5.2 Text Hep B, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20120521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20120521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20130521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20130523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 24

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text DTaP, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 25

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text IPV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 26

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151022

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.5.1 Identifier 03

OBX.5.2 Text MMR

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 27

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 21

OBX.5.2 Text Varicella

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juan Marcel Gonzales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Juan Marcel Gonzales 11/23/2011 Male

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment

Hep B Peds NOS Hepatitis B 11/23/2011 YES Complete

Hep B Peds NOS Hepatitis B 12/23/2011 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 01/22/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 03/22/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 05/21/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 02/20/2013 YES Complete

Hib, unspecified formulation Hib 01/22/2012 YES Complete

Hib, unspecified formulation Hib 03/22/2012 YES Complete

Hib, unspecified formulation Hib 05/12/2012 YES Complete

Hib, unspecified formulation Hib 02/22/2012 YES Complete

poliovirus vaccine, inactivated Polio (IPV) 01/22/2012 YES Complete

poliovirus vaccine, inactivated Polio (IPV) 03/22/2012 YES Complete

pneumococcal, unspecified formulation Polio (IPV) 05/21/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 01/22/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 03/22/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 05/21/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 11/22/2012 YES Complete

rotavirus, unspecified formulation Rotavirus 11/22/2012 YES Complete

rotavirus, unspecified formulation Rotavirus 03/22/2012 YES Complete

influenza, unspecified formulation Influenza 09/22/2012 YES Complete

influenza, unspecified formulation Influenza 10/22/2012 YES Complete

influenza, unspecified formulation Influenza 10/30/2013 Complete

Hep A, unspecified formulation Hepatitis A 05/21/2013 Complete

Hep A, unspecified formulation Hepatitis A 12/01/2013 Complete

MMRV MMR and Varicella 01/12/2013 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 05/21/2012 05/21/2012 05/21/2013

DTaP, unspecified formulation 11/22/2015 11/22/2015 11/21/2017

IPV 11/22/2015 11/22/2015 11/21/2017

influenza, unspecified formulation 10/22/2015 11/22/2015 11/21/2017

MMR 11/22/2015 11/22/2015 11/21/2017

Varicella 11/22/2015 11/22/2015 11/21/2017

3.2.2. View the vaccination forecast for Juan Marcel Gonzales returned by the Immunization Registry
Test Step Type:
The EMR displays the current Immunization Forecast to the user for Juan Marcel Gonzales as returned by the Immunization Registry Z42 response.
Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Views the vaccine forecast provided by the Immunization Registry

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juan

QPD.4.3 Second and Further Given Names or Initials Thereof Marcel

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Morales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code L

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201111231100

QPD.7 Patient Sex M

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551213

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juan

PID.5.3 Second and Further Given Names or Initials Thereof Marcel

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 201111231100

PID.8 Administrative Sex M

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4623 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111223

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130220

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120512

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120222

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 1.0

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 1.0

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120922

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121022

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131030

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130521

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131201

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130112

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text MMR and Varicella

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Thigh Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 5

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 6

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 7

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 8

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 13

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 14

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 15

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 16

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 17

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 18

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 19

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 20

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 5

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 5

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 22

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 23

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 24

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 6

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 25

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 6

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 30

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 31

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 32

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 7

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 33

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 7

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 34

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 35

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 36

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 8

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 37

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 8

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 38

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 39

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 40

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 41

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 42

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 17

OBX.5.2 Text Hib, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 43

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 44

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 10

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 45

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 10

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 46

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text poliovirus vaccine, inactivated

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 47

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 48

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 11

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 49

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 11

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 50

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text poliovirus vaccine, inactivated

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 51

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 52

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 12

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 53

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 12

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 54

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 55

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 56

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 57

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 58

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 59

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 60

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 14

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 61

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 14

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 62

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 63

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 64

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 15

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 65

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 15

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 67

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 68

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 16

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 69

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 16

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 66

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 109

OBX.5.2 Text pneumococcal, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 71

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 72

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 73

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 18

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 18

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 74

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 75

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 76

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 19

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 77

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 19

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 78

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 79

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 80

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 81

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 82

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 83

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 84

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 85

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 20

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 86

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 87

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 90

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 91

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 92

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 93

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 94

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 95

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 22

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 22

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 98

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 94

OBX.5.2 Text MMRV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 99

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 96

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 97

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 45

OBX.5.2 Text Hep B, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20120521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20120521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20130521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20130523

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 24

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text DTaP, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 25

OBX.5 Observation Value 5

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text IPV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 26

OBX.5 Observation Value 4

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151022

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.5.1 Identifier 03

OBX.5.2 Text MMR

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 27

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 21

OBX.5.2 Text Varicella

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20151122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171121

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20171122

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 28

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juan Marcel Gonzales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Juan Marcel Gonzales 11/23/2011 Male

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment

Hep B Peds NOS Hepatitis B 11/23/2011 YES Complete

Hep B Peds NOS Hepatitis B 12/23/2011 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 01/22/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 03/22/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 05/21/2012 YES Complete

diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified DTaP 02/20/2013 YES Complete

Hib, unspecified formulation Hib 01/22/2012 YES Complete

Hib, unspecified formulation Hib 03/22/2012 YES Complete

Hib, unspecified formulation Hib 05/12/2012 YES Complete

Hib, unspecified formulation Hib 02/22/2012 YES Complete

poliovirus vaccine, inactivated Polio (IPV) 01/22/2012 YES Complete

poliovirus vaccine, inactivated Polio (IPV) 03/22/2012 YES Complete

pneumococcal, unspecified formulation Polio (IPV) 05/21/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 01/22/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 03/22/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 05/21/2012 YES Complete

pneumococcal, unspecified formulation Pneumococcal conjugate (PCV13) 11/22/2012 YES Complete

rotavirus, unspecified formulation Rotavirus 11/22/2012 YES Complete

rotavirus, unspecified formulation Rotavirus 03/22/2012 YES Complete

influenza, unspecified formulation Influenza 09/22/2012 YES Complete

influenza, unspecified formulation Influenza 10/22/2012 YES Complete

influenza, unspecified formulation Influenza 10/30/2013 Complete

Hep A, unspecified formulation Hepatitis A 05/21/2013 Complete

Hep A, unspecified formulation Hepatitis A 12/01/2013 Complete

MMRV MMR and Varicella 01/12/2013 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 05/21/2012 05/21/2012 05/21/2013

DTaP, unspecified formulation 11/22/2015 11/22/2015 11/21/2017

IPV 11/22/2015 11/22/2015 11/21/2017

influenza, unspecified formulation 10/22/2015 11/22/2015 11/21/2017

MMR 11/22/2015 11/22/2015 11/21/2017

Varicella 11/22/2015 11/22/2015 11/21/2017

3.2.3. View the vaccination forecast for Juan Marcel Gonzales
Test Step Type: null
The EMR displays the current Immunization Forecast to the user for Juan Marcel Gonzales either as returned by the IIS in prior step, or as generated thru any local means.
Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and, once the vaccine history is reconciled in the EMR, the vaccine forecast is updated :

• The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EMR defined means.

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user.

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 5/21/2012
DTaP due on 11/22/2015

IPV due on 11/22/2015

MMR due on 11/22/2015

Varicella due on 11/22/2015

influenza, unspecified formulation due on Oct 22, 2015 or later

Notes to Testers

No Note

3.3. Mariela Gonzales Morales Display Reconcile Update Immunization Information
Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

3.3.1. View and import response to request for vaccination history for Mariela Gonzales Morales
Test Step Type:
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.
Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Accepts the single vaccine in the registry record into the EHR history

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Mariela Gonzales Morales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

                hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 3/30/2015

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Mariela

QPD.4.3 Second and Further Given Names or Initials Thereof

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Morales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201505301100

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551214

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Morales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Mariela

PID.5.3 Second and Further Given Names or Initials Thereof Gonzales

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 201505301100

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Stamford Regional Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150530

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Pike

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Susan

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 45

OBX.5.2 Text Hep B, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150730

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text DTaP, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 08

OBX.5.2 Text Hib

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text IPV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 152

OBX.5.2 Text Pneumococcal Conjugate, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170530

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 28

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.5.1 Identifier 03

OBX.5.2 Text MMR

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 30

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 21

OBX.5.2 Text Varicella

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 31

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Mariela Gonzales Morales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Mariela Gonzales Morales 05/30/2015 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status Tester Comment

Hep B Peds NOS Hepatitis B 05/30/2015 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 06/29/2015 06/29/2015 07/29/2015

DTaP, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

Hib 07/29/2015 07/29/2015 05/29/2017

IPV 07/29/2015 07/29/2015 05/29/2017

Pneumococcal Conjugate, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

rotavirus, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

influenza, unspecified formulation 01/12/2015 01/12/2015 05/29/2017

Hep A, unspecified formulation 05/29/2016 05/29/2016 05/29/2017

MMR 05/29/2016 05/29/2016 08/27/2016

Varicella 05/29/2016 05/29/2016 08/27/2016

3.3.2. View the vaccination forecast for Mariela Gonzales Morales returned by the Immunization Registry
Test Step Type:
The EMR displays the current Immunization Forecast to the user for Mariela Gonzales Morales as returned by the Immunization Registry Z42 response.
Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Views the vaccine forecast provided by the Immunization Registry

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

The EMR displays the information returned from the Immunization Registry according to the Juror Document.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z44

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Gonzales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Mariela

QPD.4.3 Second and Further Given Names or Initials Thereof

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Morales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code M

QPD.6 PatientDateOfBirth

QPD.6.1 Time 201505301100

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551214

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Morales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Mariela

PID.5.3 Second and Further Given Names or Initials Thereof Gonzales

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 201505301100

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Stamford Regional Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150530

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Pike

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Susan

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150730

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170530

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 28

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 30

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 31

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Mariela Gonzales Morales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 Mariela Gonzales Morales 05/30/2015 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status Tester Comment

Hep B Peds NOS Hepatitis B 05/30/2015 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 06/29/2015 06/29/2015 07/29/2015

DTaP, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

Hib 07/29/2015 07/29/2015 05/29/2017

IPV 07/29/2015 07/29/2015 05/29/2017

Pneumococcal Conjugate, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

rotavirus, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

influenza, unspecified formulation 01/12/2015 01/12/2015 05/29/2017

Hep A, unspecified formulation 05/29/2016 05/29/2016 05/29/2017

MMR 05/29/2016 05/29/2016 08/27/2016

Varicella 05/29/2016 05/29/2016 08/27/2016

3.3.3. View the vaccination forecast for Mariela Gonzales Morales
Test Step Type:
The EMR displays the current Immunization Forecast to the user for Mariela Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.
Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

No Comments

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Mariela Gonzales Morales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user.

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015
Hib due on 7/29/2015

IPV due on 7/29/2015

Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015
HepA due on 5/29/2016
MMR due on 5/29/2016

Varicella due on 5/29/2016

influenza, unspecified formulation due on Nov 26, 2015 or later

Notes to Testers

No Note

3.4. Juana Maria Gonzales Morales Display Reconcile Update Immunization Information
Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

3.4.1. View and import response to request for vaccination history for Juana Maria Gonzales Morales
Test Step Type:
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.
Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Accepts the single vaccine in the registry record into the EHR history

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales Morales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

                hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 3/30/2015

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z42

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Morales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana

QPD.4.3 Second and Further Given Names or Initials Thereof Maria Gonzales

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Gonzales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code F

QPD.6 PatientDateOfBirth

QPD.6.1 Time 053020151100

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551214

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name BG2

PID.5.3 Second and Further Given Names or Initials Thereof

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 053020151115

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Stamford Regional Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150530

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Pike

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Susan

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 31

OBX.5.2 Text Hep B Peds NOS

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 45

OBX.5.2 Text Hep B, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150730

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 107

OBX.5.2 Text DTaP, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 08

OBX.5.2 Text Hib

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 10

OBX.5.2 Text IPV

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 152

OBX.5.2 Text Pneumococcal Conjugate, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 122

OBX.5.2 Text rotavirus, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 88

OBX.5.2 Text influenza, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 85

OBX.5.2 Text Hep A, unspecified formulation

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170530

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 28

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.5.1 Identifier 03

OBX.5.2 Text MMR

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 30

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier 21

OBX.5.2 Text Varicella

OBX.5.3 Name of Coding System CVX

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC16

OBX.5.2 Text ACIP

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 31

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juana Maria Gonzales Morales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 BG2 Gonzales 20/15/0530 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status Tester Comment

Hep B Peds NOS Hepatitis B 05/30/2015 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 06/29/2015 06/29/2015 07/29/2015

DTaP, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

Hib 07/29/2015 07/29/2015 05/29/2017

IPV 07/29/2015 07/29/2015 05/29/2017

Pneumococcal Conjugate, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

rotavirus, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

influenza, unspecified formulation 01/12/2015 01/12/2015 05/29/2017

Hep A, unspecified formulation 05/29/2016 05/29/2016 05/29/2017

MMR 05/29/2016 05/29/2016 08/27/2016

Varicella 05/29/2016 05/29/2016 08/27/2016

3.4.2. View the vaccination forecast for Juana Maria Gonzales Morales returned by the Immunization Registry
Test Step Type:
The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales as returned by the Immunization Registry Z42 response.
Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Views the vaccine forecast provided by the Immunization Registry

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID MYIIS

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID MyStateIIS

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID MYEHR

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID Myclinic

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20091130020020-0500

MSH.9 Message Type

MSH.9.1 Message Code RSP

MSH.9.2 Trigger Event K11

MSH.9.3 Message Structure RSP_K11

MSH.10 Message Control ID 7731029

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type NE

MSH.16 Application Acknowledgment Type NE

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z42

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name A_Clinic

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID X68

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code AN

MSH.22.10 Organization Identifier A_Clinic1234

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

MSA : Message Acknowledgment

Location Data Element Data Categorization

MSA.1 Acknowledgment Code AA

MSA.2 Message Control ID 793543

QAK : Query Acknowledgment

Location Data Element Data Categorization

QAK.1 Query Tag 37374859

QAK.2 Query Response Status OK

QAK.3 Message Query Name

QAK.3.1 Identifier Z44

QAK.3.2 Text Request Evaluated History and Forecast

QAK.3.3 Name of Coding System CDCPHINVS

QAK.3.5 Alternate Text

QAK.3.6 Name of Alternate Coding System

QPD : Query Parameter Definition

Location Data Element Data Categorization

QPD.1 Message Query Name

QPD.1.1 Identifier Z42

QPD.1.2 Text Request Evaluated History and Forecast

QPD.1.3 Name of Coding System CDCPHINVS

QPD.1.5 Alternate Text

QPD.1.6 Name of Alternate Coding System

QPD.2 Query Tag 37374859

QPD.3 PatientList

QPD.3.1 ID Number

QPD.3.3 Check Digit Scheme

QPD.3.4 Assigning Authority

QPD.3.4.1 Namespace ID

QPD.3.4.2 Universal ID

QPD.3.4.3 Universal ID Type

QPD.3.5 Identifier Type Code

QPD.4 PatientName

QPD.4.1 Family Name

QPD.4.1.1 Surname Morales

QPD.4.1.2 Own Surname Prefix

QPD.4.1.3 Own Surname

QPD.4.1.4 Surname Prefix From Partner/Spouse

QPD.4.1.5 Surname From Partner/Spouse

QPD.4.2 Given Name Juana

QPD.4.3 Second and Further Given Names or Initials Thereof Maria Gonzales

QPD.4.7 Name Type Code L

QPD.5 PatientMotherMaidenName

QPD.5.1 Family Name

QPD.5.1.1 Surname Gonzales

QPD.5.1.2 Own Surname Prefix

QPD.5.1.3 Own Surname

QPD.5.1.4 Surname Prefix From Partner/Spouse

QPD.5.1.5 Surname From Partner/Spouse

QPD.5.7 Name Type Code F

QPD.6 PatientDateOfBirth

QPD.6.1 Time 053020151100

QPD.7 Patient Sex F

QPD.8 Patient Address

QPD.8.1 Street Address

QPD.8.1.1 Street or Mailing Address 3321 Standish Way

QPD.8.1.2 Street Name

QPD.8.1.3 Dwelling Number

QPD.8.2 Other Designation

QPD.8.3 City Stamford

QPD.8.4 State or Province CT

QPD.8.5 Zip or Postal Code 06903

QPD.8.6 Country

QPD.8.7 Address Type L

QPD.9 Phone

QPD.9.2 Telecommunication Use Code PRN

QPD.9.3 Telecommunication Equipment Type PH

QPD.9.4 Email Address

QPD.9.6 Area/City Code 203

QPD.9.7 Local Number 5551214

QPD.10 Multiple birth indicator

QPD.11 Birth order

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name BG2

PID.5.3 Second and Further Given Names or Initials Thereof

PID.5.7 Name Type Code L

PID.7 Date/Time of Birth

PID.7.1 Time 053020151115

PID.8 Administrative Sex F

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT

PID.11.5 Zip or Postal Code 06903

PID.11.6 Country USA

PID.11.7 Address Type L

PID.30 Patient Death Indicator

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier

ORC.17.2 Text Stamford Regional Hospital

ORC.17.3 Name of Coding System

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197023

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.17 Entering Organization

ORC.17.1 Identifier STIIS

ORC.17.2 Text StateIIS

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150530

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Pike

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Susan

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150601

RXA.5 Administered Code

RXA.5.1 Identifier 998

RXA.5.2 Text no vaccine admin

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 4

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 59782-3

OBX.3.2 Text number of doses in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 3

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 100

OBX.2 Value Type ID

OBX.3 Observation Identifier

OBX.3.1 Identifier 59781-5

OBX.3.2 Text Dose validity

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value Y

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 3

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150629

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150730

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value 2

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 4

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 9

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 13

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 17

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20150729

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 21

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 201501126

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 23

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 106

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 107

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20170530

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 109

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 28

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 110

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 2

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 111

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 112

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 113

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 30

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 114

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30956-7

OBX.3.2 Text vaccine type

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 115

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 59779-9

OBX.3.2 Text Immunization Schedule used

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30981-5

OBX.3.2 Text Earliest date to give

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 116

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 30980-7

OBX.3.2 Text Date vaccination due

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160529

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59777-3

OBX.3.2 Text Latest date next dose may be given

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160827

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 108

OBX.2 Value Type DT

OBX.3 Observation Identifier

OBX.3.1 Identifier 59778-1

OBX.3.2 Text Date dose is overdue

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value 20160828

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 117

OBX.2 Value Type NM

OBX.3 Observation Identifier

OBX.3.1 Identifier 30973-2

OBX.3.2 Text dose number in series

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 31

OBX.5 Observation Value 1

OBX.6 Units

OBX.6.1 Identifier NA

OBX.6.2 Text

OBX.6.3 Name of Coding System HL70353

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast

Test Case ID Juana Maria Gonzales Morales Display Reconcile Update Immunization Information

Juror ID

Juror Name

HIT System Tested

Inspection Date/Time

Inspection Settlement

Pass Fail

Reason Failed

Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.

Patient Information

Patient Identifier Patient Name DOB Gender Tester Comment

123456 BG2 Gonzales 20/15/0530 Female

When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.

Evaluated Immunization History and Immunization Forecast

Immunization Schedule Used Tester Comment

ACIP

Evaluated Immunization History

Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status Tester Comment

Hep B Peds NOS Hepatitis B 05/30/2015 YES Complete

* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".

Immunization Forecast

Vaccine Group Due Date Earliest Date To Give Latest Date to Give Series Status Forecast Reason Tester Comment

Hep B, unspecified formulation 06/29/2015 06/29/2015 07/29/2015

DTaP, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

Hib 07/29/2015 07/29/2015 05/29/2017

IPV 07/29/2015 07/29/2015 05/29/2017

Pneumococcal Conjugate, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

rotavirus, unspecified formulation 07/29/2015 07/29/2015 05/29/2017

influenza, unspecified formulation 01/12/2015 01/12/2015 05/29/2017

Hep A, unspecified formulation 05/29/2016 05/29/2016 05/29/2017

MMR 05/29/2016 05/29/2016 08/27/2016

Varicella 05/29/2016 05/29/2016 08/27/2016

3.4.3. View the vaccination forecast for Juana Maria Gonzales Morales
Test Step Type:
The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.
Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

No Comments

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales Morales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user.

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015
Hib due on 7/29/2015

IPV due on 7/29/2015

Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015
HepA due on 5/29/2016
MMR due on 5/29/2016

Varicella due on 5/29/2016

influenza, unspecified formulation due on Nov 26, 2015 or later

Notes to Testers

No Note

4. Order and Immunize patient
This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. NOTE: There are no orders or immunizations in this test plan for Juana Maria Gonzales.
4.1. Juana Mariana Gonzales, Enter Orders and Immunizations
Orders and Immunization events, non-administrations, and alerts presented for current visit.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

4.1.1. Order IPV and view prior reaction
Test Step Type:
The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.
Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).

Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Value/Text for Vaccine Type IPV (CVX 10)

Date/Time Vaccine Refusal was recorded Current Date

Alert Alerts user to information about the prior febrile seizure post-IPV vaccine

Notes to Testers

No Note

4.1.2. IPV Parental Refusal
Test Step Type:
Documents mother?s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.
Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Comments

No Comments

PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.

PostCondition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent.

Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria

EMR documents the non-administration of the IPV due to the parental refulsal:

Substance/Treatment Refusal Reason Parental decision (NIP002 00)

Completion Status RE

Date/Time Vaccine Deferral was recorded Current Date

Deferral Reason Parental decision (NIP002 00)

Deferral Status Permanent

Notes to Testers

No Note

4.1.3. Order Influenza vaccine and view allergy alert
Test Step Type:
The provider orders inactivated influenza vaccine and is notified that the patient as allergy to egg albumin.
Test Story

Description

The provider orders inactivated influenza vaccine and is notified that the patient as allergy to egg albumin

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

Intranasal form of the Influenza vaccine is ordered for the patient.

Test Objectives

Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Order Value/Text for Vaccine Type Influenza, injectable,quadrivalent, preservative free, pediatric (CVX161)

Date/Time Vaccine was recorded Current Date

Alert Alerts user to information that patient has Egg Allergy

Provider changes the order to modifies the Vaccine type:

Vaccine Type: Influenza virus vaccine, live, attenuated, for intranasal use (CVX 111)

Notes to Testers

No Note

4.1.4. Order MMRV Vaccine
Test Step Type:
The provider orders an MMRV vaccine as a catch-up dose.
Test Story

Description

As indicated by the vaccine forecast, the first MMRV administered was invalid as it was administered too soon. The provider orders MMRV as a catch-up dose.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

MMRV vaccine is ordered for the patient.

Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Order Value/Text for Vaccine Type measles, mumps, rubella, and varicella virus vaccine (CVX 94 )

Date/Time Vaccine was recorded Current Date

Notes to Testers

No Note

4.1.5. Records Influenza Vaccine administration route with data validation checking
Test Step Type: null
The provider records the vaccine administration in the EMR and is prevented from incorrectly documenting vaccine route.
Test Story

Description

The nurse documents administration route for the nasal live, attenuated influenza vaccine
• Is prevented from documenting “IM” for live, attenuated influenza vaccine

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for nasal live, attenuated influenza vaccine.

PostCondition

The nasal live, attenuated influenza vaccination route has failed to be recorded as intramuscular in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.

Evaluation Criteria

The EMR prevents the user for entering 'Intramuscular' as a route for the the nasal live, attenuated influenza vaccine.

Notes to Testers

No Note

4.1.6. Record Influenza Vaccine administration
Test Step Type:
The provider documents in the EMR all attributes associated with the new vaccine administration.
Test Story

Description

The nurse administers the the nasal live, attenuated influenza vaccine
• Documents all required information for each vaccine

Comments

No Comments

PreCondition

Order is placed for nasal live, attenuated influenza vaccine.

PostCondition

The nasal live, attenuated influenza vaccinations is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source (Administration Notes) New immunization record (NIP001 00)

Value/Text for Vaccine Type influenza virus vaccine, live, attenuated, for intranasal use (CVX 111), FluMist Quadrivalent (NDC 66019-0301-10)

Date/Time of Start of Administration Current Date

Vaccine Administered influenza virus vaccine, live, attenuated, for intranasal use (CVX 111), FluMist Quadrivalent (NDC 66019-0301-10)

Administered Amount (of Vaccine) 0.2

Administered Units (of Measure) mL

Administering Provider Sandra Molina

Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901

Lot Number 8L4B3521

Substance Expiration Date 8/15/2015

Substance Manufacturer Name MedImmune,LLC (MVX MED)

Completion Status CP

Route of Administration Nasal (NCIT C38284), Nasal (HL70162 NS)

Administration Site

VFC Eligibility No



Notes to Testers

No Note

4.1.7. Records MMRV Vaccine administration route with data validation checking
Test Step Type: null
The provider records the vaccine administration route in the EMR and is prevented from incorrectly documenting vaccine route
Test Story

Description

The nurse documents administration route for the MMRV vaccine
• Is prevented from documenting “oral” for MMRV vaccine

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for MMRV vaccine.

PostCondition

The MMRV vaccination route has failed to be recorded as 'oral' in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.

Evaluation Criteria

The EMR prevents the user for entering 'Oral' as a route for the the MMRV vaccine.

Notes to Testers

No Note

4.1.8. Record MMRV Vaccine administration
Test Step Type:
The provider documents in the EMR all attributes associated with the new vaccine administration.
Test Story

Description

The nurse administers the the MMRV vaccine
• Documents all required information for each vaccine

Comments

No Comments

PreCondition

Order is placed for MMRV vaccine.

PostCondition

The MMRV vaccination is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Order Value/Text for Vaccine Type measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), ProQuad (NDC 00006-4999-00)

Date/Time Vaccine was recorded Current Date

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Date/Time of Start of Administration Current Date

Vaccine Administered measles, mumps, rubella, and varicella virus vaccine (CVX 94 ),
ProQuad (NDC 00006-4999-00)

Administered Amount (of Vaccine) 0.5

Administered Units (of Measure) mL

Administration Notes

Administering Provider Sandra Molina

Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901

Lot Number 7W87V3687

Substance Expiration Date 7/15/2015

Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD)

Completion Status CP

Route of Administration Subcutaneous (NCIT C38299, HL70162: SC)

Administration Site Left Deltoid (HL70162 LD)

VFC Eligibility No

Notes to Testers

No Note

4.2. Juan Marcel Gonzales, Enter Orders and Immunizations
Orders and Immunization events, non-administrations, and alerts presented for current visit.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

4.2.1. Order intranasal, live virus influenza vaccine and view asthma contraindication
Test Step Type:
Selects selects to order intranasal, live virus influenza vaccine and views information about patient asthma problem which is a contraindication to the intranasal vaccine.
Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Orders administration of Influenza vaccine (intranasal, live virus vaccine)

• Receives notification the patient has asthma, a relative contraindication for intranasal influenza vaccine

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

User notified of history of contraindication tto nfluenza virus vaccine, live, attenuated, for intranasal use (CVX 111)
of asthma on problem list. Order is changed to Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
.

Test Objectives

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s current or historical diagnoses.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Value/Text for Vaccine Type influenza virus vaccine, live, attenuated, for intranasal use (CVX 111)

Date/Time Vaccine Refusal was recorded Current Date

Alert Notification the patient has asthma, a relative contraindication for intranasal influenza vaccine.

The Provider changes the order to:

Vaccine Type: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

Notes to Testers

No Note

4.2.2. Orders administration of Hepatitis B vaccine
Test Step Type:
The provider orders a Hepatitis B vaccine (dose 3).
Test Story

Description

As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast reviewed.

PostCondition

Hepatitis B vaccine is ordered for the patient.

Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Order Value/Text for Vaccine Type hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

Date/Time Vaccine was recorded Current Date

Notes to Testers

No Note

4.2.3. Orders administration of DTaP vaccine and alerted that the dose is too early
Test Step Type:
The provider orders a DTaP vaccine (dose 5). The EMR provides an alert that the vaccine dose is too early.
Test Story

Description

The fifth DTaP is ordered, and the provider is notified that the dose is too early.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast is available in the EMR.

PostCondition

DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early.

Test Objectives

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Value/Text for Vaccine Type diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

Date/Time Vaccine order was recorded Current Date

Alert Notification that the dose is too early

Notes to Testers

No Note

4.2.4. Records Hepatitis B Vaccine lot number with expired lot alert
Test Step Type:
The provider records the vaccine administration lot number in the EMR and is alerted of the expired lot.
Test Story

Description

The nurse documents administration lot number for the Hepatitis B vaccine
• Is prevented from ordering the Hepatitis B lot as it has expired
• Documents administration from a different lot that is not expired

Comments

PreCondition

Order is placed for Hepatitis B vaccine.

PostCondition

The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EMR.

Test Objectives

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Date/Time of Start of Administration Current Date

Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)

Lot Number (Expired) 6332FK18

Substance Expiration Date (Expired) 6/15/2015

Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB)

Alert Alerts user to expired lot

Notes to Testers

No Note

4.2.5. Record Hepatitis B Vaccine administration
Test Step Type:
The EMR is able to document all attributes associated with the new vaccine administration.
Test Story

Description

The nurse administers the the Hepatitis B vaccine
• Documents all required information for the vaccine

Comments

No Comments

PreCondition

Order is placed for Hepatitis B vaccine.

PostCondition

The Hepatitis B vaccination is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Date/Time of Start of Administration Current Date

Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)

Administered Amount (of Vaccine) 0.5

Administered Units (of Measure) mL

Administration Notes

Administering Provider Sandra Molina

Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901

Lot Number 6332FK26

Substance Expiration Date 8/25/2015

Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB)

Completion Status CP

Route of Administration Intramuscular (NCIT C28161, HL70162: IM)

Administration Site Left Deltoid (HL70162 LD)

VFC Eligibility No

Notes to Testers

No Note

4.2.6. Records Influenza Vaccine administration with VFC eligibility checking
Test Step Type:
The provider records the vaccine administration from a VFC source and alerted that the patient is not VFC eligible.
Test Story

Description

The nurse documents administration for the inactivated influenza vaccine from a VFC source
• Is alerted that the patient is not eligible for VFC
• Orders a different non-VFC lot of inactivated influenza vaccine

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for inactivated influenza vaccine.

PostCondition

The user is notified of vaccine dose ineligibility.

Test Objectives

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.

Evaluation Criteria

The provider documents a VFC lot to be administered in the EMR. Once notified that the patient is not eligible for the VFC, the a non-VFC lot is selected.

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Value/Text for Vaccine Type Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Date/Time of Start of Administration Current Date

Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

VFC lot (not administered) D8043IN8422

Substance Expiration Date 8/15/2015

Substance Manufacturer Name Sanofi Pasteur (MVX PMC)

Alert Patient is not VFC Eligible

The Provider selects a non-VFC Lot:

Vaccine Lot # (administered): D8043IN8855

Vaccine Expiration Date: 8/25/2015

Notes to Testers

No Note

4.2.7. Record Influenza Vaccine administration for Juan Marcel Gonzales
Test Step Type:
The EMR is able to document all attributes associated with the new vaccine administration.
Test Story

Description

The nurse administers the inactivated influenza vaccine
• Documents all required information for each vaccine

Comments

No Comments

PreCondition

Order is placed for inactivated influenza vaccine.

PostCondition

The inactivated influenza vaccine administration is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source (Administration Notes) New immunization record (NIP001 00)

Value/Text for Vaccine Type Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Date/Time of Start of Administration Current Date

Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)

Administered Amount (of Vaccine) 0.25

Administered Units (of Measure) mL

Administering Provider Sandra Molina

Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901

Lot Number D8043IN8855

Substance Expiration Date 8/25/2015

Substance Manufacturer Name Sanofi Pasteur (MVX PMC)

Completion Status CP

Route of Administration Intramuscular (NCIT C28161, HL70162: IM)

Administration Site Left Thigh (HL7 LT)

VFC Eligibility No

Notes to Testers

No Note

4.3. Mariela Gonzales Morales, Enter Orders and Immunizations
Orders and Immunization events, non-administrations, and alerts presented for current visit.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

4.3.1. Enters a deferral for the vaccines due
Test Step Type:
Enters a deferral for vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month.
Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:
• Enters a deferral for the vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month

Comments

No Comment

PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry. Vaccine forecast is available in the EMR indicating 5 vaccines are due: Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus

PostCondition

Vaccine deferral is recorded indicating the medical reason of low grade fever

Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina

Ordering Provider Frank Smith

Entering Organization Shoreline Pediatrics

Vaccine Event information source New immunization record (NIP001 00)

Value/Text for Vaccine Type hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
pneumococcal conjugate vaccine, 13 valent (CVX 133)
rotavirus, live, monovalent vaccine (CVX 119)

Date/Time Vaccine not administered was recorded Current Date

Alert contraindication of fever

Substance/Treatment Deferral Start Date:Vaccination contraindication/precaution effective date (30946-8 LOINC) Current Date

Substance/Treatment Deferral End Date/Vaccination temporary contraindication/precaution expiration date (30944-3 LOINC) : Current Date +30 Days

Substance/Treatment Deferral Contraindication: Vaccination contraindication/precaution (30945-0 LOINC): current fever with moderate-to-severe illness (PHVS_VaccinationContraindication_IIS - VXC23)

Completion Status: NA

Date/Time Vaccine Deferral was recorded: Current Date

Notes to Testers

No Note

5. Transmit Immunization Report
This test will consist of generating a Vaccine Update (VXU-Z22) report to the registry for three of the test patients, including updates for vaccines not given. NOTE: There is no Immunization Report in this test plan for Juana Maria Gonzales.
5.1. Juana Mariana Gonzales Transmit Immunization Report
Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Gonzales.
Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

No PostCondition

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

5.1.1. Transmit the immunization report to the Immunization Registry
Test Step Type:
The EMR send the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.
Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID Test EHR Application

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID X68

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID NIST Test Iz Reg

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20120701082240-0500

MSH.9 Message Type

MSH.9.1 Message Code VXU

MSH.9.2 Trigger Event V04

MSH.9.3 Message Structure VXU_V04

MSH.10 Message Control ID NIST-IZ-001.00

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z22

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales Test Case Fixed

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juana Test Case Fixed

PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed

PID.5.7 Name Type Code L Test Case Fixed

PID.6 Mother's Maiden Name

PID.6.1 Family Name

PID.6.1.1 Surname Acosta Test Case Fixed

PID.6.1.2 Own Surname Prefix

PID.6.1.3 Own Surname

PID.6.1.4 Surname Prefix From Partner/Spouse

PID.6.1.5 Surname From Partner/Spouse

PID.6.7 Name Type Code M Test Case Fixed

PID.7 Date/Time of Birth

PID.7.1 Time 200911231105 Test Case Fixed

PID.8 Administrative Sex F Test Case Fixed

PID.10 Race

PID.10.1 Identifier 2106-3 Test Case Fixed

PID.10.2 Text White Test Case Fixed

PID.10.3 Name of Coding System HL70005 Test Case Fixed

PID.10.5 Alternate Text

PID.10.6 Name of Alternate Coding System

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford Test Case Fixed

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06903 Test Case Fixed

PID.11.6 Country USA Test Case Fixed

PID.11.7 Address Type L Test Case Fixed

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 325 Shorline Drive

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06901

PID.11.6 Country

PID.11.7 Address Type BDL Test Case Fixed

PID.13 Phone Number - Home

PID.13.2 Telecommunication Use Code PRN Test Case Fixed

PID.13.3 Telecommunication Equipment Type PH Test Case Fixed

PID.13.4 Email Address

PID.13.6 Area/City Code 203 Test Case Fixed

PID.13.7 Local Number 5551212 Test Case Fixed

PID.22 Ethnic Group

PID.22.1 Identifier 2135-2 Test Case Fixed

PID.22.2 Text Hispanic or Latino Test Case Fixed

PID.22.3 Name of Coding System CDCREC Test Case Fixed

PID.22.5 Alternate Text

PID.22.6 Name of Alternate Coding System

PID.24 Multiple Birth Indicator

PID.25 Birth Order

PID.29 Patient Death Date and Time

PID.29.1 Time

PID.30 Patient Death Indicator

PD1 : Patient Additional Demographic

Location Data Element Data Categorization

PD1.11 Publicity Code

PD1.11.1 Identifier 02

PD1.11.2 Text Reminder/Recall - any method

PD1.11.3 Name of Coding System HL70215

PD1.11.5 Alternate Text

PD1.11.6 Name of Alternate Coding System

PD1.12 Protection Indicator

PD1.13 Protection Indicator Effective Date

PD1.16 Immunization Registry Status A

PD1.17 Immunization Registry Status Effective Date 20120701

PD1.18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties

Location Data Element Data Categorization

NK1.1 Set ID - NK1 1

NK1.2 Name

NK1.2.1 Family Name

NK1.2.1.1 Surname Gonzales

NK1.2.1.2 Own Surname Prefix

NK1.2.1.3 Own Surname

NK1.2.1.4 Surname Prefix From Partner/Spouse

NK1.2.1.5 Surname From Partner/Spouse

NK1.2.2 Given Name Joanna Test Case Fixed

NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed

NK1.2.7 Name Type Code L Test Case Fixed

NK1.3 Relationship

NK1.3.1 Identifier GRP Test Case Fixed

NK1.3.2 Text Grandparent Test Case Fixed

NK1.3.3 Name of Coding System HL70063 Test Case Fixed

NK1.3.5 Alternate Text

NK1.3.6 Name of Alternate Coding System

NK1.4 Address

NK1.4.1 Street Address

NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed

NK1.4.1.2 Street Name

NK1.4.1.3 Dwelling Number

NK1.4.2 Other Designation

NK1.4.3 City Stamford Test Case Fixed

NK1.4.4 State or Province CT Test Case Fixed

NK1.4.5 Zip or Postal Code 06901 Test Case Fixed

NK1.4.6 Country

NK1.4.7 Address Type L Test Case Fixed

NK1.5 Phone Number

NK1.5.2 Telecommunication Use Code PRN Test Case Fixed

NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed

NK1.5.4 Email Address

NK1.5.6 Area/City Code 203 Test Case Fixed

NK1.5.7 Local Number 5551212 Test Case Fixed

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Sirtis

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Lisa

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Carter

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Jane

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SH

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Ricci

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Gina

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Sirtis

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Lisa

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6332FK33

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101214

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100115

RXA.5 Administered Code

RXA.5.1 Identifier 45

RXA.5.2 Text hepatitis B vaccine, unspecified formulation

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 01

RXA.9.2 Text Historical Immunization

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6352FK1

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101001

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101030

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6352FK24

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120831

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 107

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2341

RXA.16 Substance Expiration Date

RXA.16.1 Time 20111130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2433

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110904

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS3255

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101201

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS249

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110301

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20140831

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 02

RXA.9.2 Text Historical information - from other provider

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Casera

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Linda

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D643QS8243

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140901

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M54K9245

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100324

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M55K3342

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101030

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M75K4566

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100523

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M53K5534

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110222

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV2431

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101004

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV4344

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100323

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 02

RXA.9.2 Text Historical information - from other provider

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Casera

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Linda

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D335PV9644

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110222

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150519

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier 00

RXA.18.2 Text Parental decision

RXA.18.3 Name of Coding System NIP002

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status RE

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100121

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P243V3281

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P343V8321

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100330

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V2164

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100830

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V58532

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110418

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV533

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV932

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100510

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100925

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8734

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101027

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8734

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111002

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D9334IN9333

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120522

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131015

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 03

RXA.9.2 Text Historical information - from parents written record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Ricci

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Gina

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 8L4B3423

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140701

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MED

RXA.17.2 Text MedImmune, LLC

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 149 Test Case Fixed

RXA.5.2 Text influenza, live, intranasal, quadrivalent Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text FluMist Quadrivalent Test Case Fixed

RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed

RXA.6 Administered Amount 0.2 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier mL Test Case Fixed

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM Test Case Fixed

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00 Test Case Fixed

RXA.9.2 Text New immunization record Test Case Fixed

RXA.9.3 Name of Coding System NIP001 Test Case Fixed

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina Test Case Fixed

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra Test Case Fixed

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 8L4B3521 Test Case Fixed

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150815 Test Case Fixed

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MED Test Case Fixed

RXA.17.2 Text MedImmune,LLC Test Case Fixed

RXA.17.3 Name of Coding System MVX Test Case Fixed

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP Test Case Fixed

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121104

RXA.5 Administered Code

RXA.5.1 Identifier 149

RXA.5.2 Text influenza, live, intranasal, quadrivalent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FluMist Quadrivalent

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D9553IN2243

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120430

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT33

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120124

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120523

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT48

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120911

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101023

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 01

RXA.9.2 Text historical

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W27V7491

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W87V3452

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130413

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 94 Test Case Fixed

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text ProQuad Test Case Fixed

RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed

RXA.6 Administered Amount 0.5 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier mL Test Case Fixed

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM Test Case Fixed

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00 Test Case Fixed

RXA.9.2 Text New immunization record Test Case Fixed

RXA.9.3 Name of Coding System NIP001 Test Case Fixed

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina Test Case Fixed

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra Test Case Fixed

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150715 Test Case Fixed

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD Test Case Fixed

RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed

RXA.17.3 Name of Coding System MVX Test Case Fixed

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP Test Case Fixed

RXA.21 Action Code - RXA A

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38284

RXR.1.2 Text Nasal

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Nasal

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier BN

RXR.2.2 Text Bilateral Nares

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38284 Test Case Fixed

RXR.1.2 Text Nasal Test Case Fixed

RXR.1.3 Name of Coding System NCIT Test Case Fixed

RXR.1.5 Alternate Text Nasal Test Case Fixed

RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed

RXR.2 Administration Site

RXR.2.1 Identifier BN

RXR.2.2 Text Bilateral Nares

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299 Test Case Fixed

RXR.1.2 Text Subcutaneous Test Case Fixed

RXR.1.3 Name of Coding System NCIT Test Case Fixed

RXR.1.5 Alternate Text Subcutaneous Test Case Fixed

RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed

RXR.2 Administration Site

RXR.2.1 Identifier LD Test Case Fixed

RXR.2.2 Text Left Deltoid Test Case Fixed

RXR.2.3 Name of Coding System HL70163 Test Case Fixed

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 21

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 31044-1

OBX.3.2 Text Reaction

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC12

OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100522

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9 Test Case Fixed

OBX.3.2 Text VIS Publication Date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20140819

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7 Test Case Fixed

OBX.3.2 Text VIS Presentation Date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7 Test Case Fixed

OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier V01

OBX.5.2 Text Not VFC elig

OBX.5.3 Name of Coding System HL70064

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9 Test Case Fixed

OBX.3.2 Text VIS Publication Date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7 Test Case Fixed

OBX.3.2 Text VIS Presentation Date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7 Test Case Fixed

OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier V01

OBX.5.2 Text Not VFC elig

OBX.5.3 Name of Coding System HL70064

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information

Element Data

Patient Name Juana Mariana Gonzales

Mother's Maiden Name Maria Acosta

ID Number 123456 987633

Date/Time of Birth 11/23/2009

Administrative Sex Female

Patient Address 4345 Standish Way Stamford CT 06903 USA

Patient Address 1 325 Shorline Drive Stamford CT 06901

Local Number (203)555-1212

Race White

Ethnic Group Hispanic or Latino

Birth Order

Immunization Registry Information

Element Data

Immunization Registry Status A

Immunization Registry Status Effective Date 07/01/2012

Publicity Code Reminder/Recall - any method

Publicity Code Effective Date 07/01/2012

Protection Indicator

Protection Indicator Effective Date

Guardian or Responsible Party

Element Data

Name Joanna Merida Gonzales

Relationship Grandparent

Address 4345 Standish Way Stamford CT 06901

Phone Number (203)555-1212

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage

Date/Time Start of Administration 11/23/2009

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider Lisa Sirtis

Substance Lot Number 6332FK33

Substance Expiration Date 12/14/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Shoreline Hospital

Entered By Lisa Sirtis

Ordered By Jane Carter

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, unspecified formulation

Date/Time Start of Administration 01/15/2010

Administered Amount 999

Administered Units

Administration Notes Historical Immunization

Administering Provider Sandra Molina

Substance Lot Number 6352FK1

Substance Expiration Date 10/01/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage

Date/Time Start of Administration 10/30/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6352FK24

Substance Expiration Date 08/31/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS2341

Substance Expiration Date 11/30/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS2433

Substance Expiration Date 09/04/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS3255

Substance Expiration Date 12/01/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Historical information - from public agency

Element Data

Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS249

Substance Expiration Date 03/01/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 08/31/2014

Administered Amount 999

Administered Units

Administration Notes Historical information - from other provider

Administering Provider Linda Casera

Substance Lot Number D643QS8243

Substance Expiration Date 09/01/2014

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By J Rodriguez

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M54K9245

Substance Expiration Date 03/24/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M55K3342

Substance Expiration Date 10/30/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M75K4566

Substance Expiration Date 05/23/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M53K5534

Substance Expiration Date 02/22/2011

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D333PV2431

Substance Expiration Date 10/04/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D333PV4344

Substance Expiration Date 03/23/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from other provider

Administering Provider Linda Casera

Substance Lot Number D335PV9644

Substance Expiration Date 02/22/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By J Rodriguez

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 05/19/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason Parental decision

Completion Status RE

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 01/21/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P243V3281

Substance Expiration Date 01/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P343V8321

Substance Expiration Date 03/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P853V2164

Substance Expiration Date 08/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P853V58532

Substance Expiration Date 04/18/2011

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code rotavirus, live, monovalent vaccine

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RV533

Substance Expiration Date 02/15/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code rotavirus, live, monovalent vaccine

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RV932

Substance Expiration Date 05/10/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 09/25/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D8043IN8734

Substance Expiration Date 03/12/2011

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/27/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D8043IN8734

Substance Expiration Date 03/12/2011

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/02/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D9334IN9333

Substance Expiration Date 05/22/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/15/2013

Administered Amount 999

Administered Units

Administration Notes Historical information - from parents written record

Administering Provider Gina Ricci

Substance Lot Number 8L4B3423

Substance Expiration Date 07/01/2014

Substance Manufacturer Name MedImmune, LLC

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Nasal

Administration Site Bilateral Nares

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Gina Ricci

Vaccine Administration Information

Element Data

Administered Code influenza, live, intranasal, quadrivalent

Date/Time Start of Administration 07/15/2015

Administered Amount 0.2

Administered Units

Administration Notes New immunization record

Administering Provider Sandra Molina

Substance Lot Number 8L4B3521

Substance Expiration Date 08/15/2015

Substance Manufacturer Name MedImmune,LLC

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Nasal

Administration Site Bilateral Nares

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Observations

Element Data

VIS Publication Date 08/19/2014

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information

Element Data

Administered Code influenza, live, intranasal, quadrivalent

Date/Time Start of Administration 11/04/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D9553IN2243

Substance Expiration Date 04/30/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

Date/Time Start of Administration 11/23/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RT33

Substance Expiration Date 01/24/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

Date/Time Start of Administration 05/23/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RT48

Substance Expiration Date 09/11/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 10/23/2010

Administered Amount 999

Administered Units

Administration Notes historical

Administering Provider J Martinez

Substance Lot Number 7W27V7491

Substance Expiration Date 12/15/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 11/22/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7W87V3452

Substance Expiration Date 04/13/2013

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 07/15/2015

Administered Amount 0.5

Administered Units

Administration Notes New immunization record

Administering Provider Sandra Molina

Substance Lot Number 7W87V3687

Substance Expiration Date 07/15/2015

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Observations

Element Data

VIS Publication Date 05/21/2010

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

5.1.2. Record an adverse reaction
Test Step Type: null
The Provider records in the EMR an adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose.
Test Story

Description

Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours.

Comments

No Comments

PreCondition

The vaccinations for the visit have been administered.

PostCondition

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Verify that vendor can record the adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission

Notes to Testers

No Note

5.1.3. Transmit the updated vaccination report with adverse reaction to the registry
Test Step Type:
The EMR generates a Z22 Send Unsolicited Immunization Update Using a VXU correctly and without omission according to supplied test data.
Test Story

Description

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message.

Comments

No Comments

PreCondition

An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

PostCondition

The adverse reaction has been transmitted to the IIS.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID Test EHR Application

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID X68

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID NIST Test Iz Reg

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20120701082240-0500

MSH.9 Message Type

MSH.9.1 Message Code VXU

MSH.9.2 Trigger Event V04

MSH.9.3 Message Structure VXU_V04

MSH.10 Message Control ID NIST-IZ-001.00

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z22

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales Test Case Fixed

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juana Test Case Fixed

PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed

PID.5.7 Name Type Code L Test Case Fixed

PID.6 Mother's Maiden Name

PID.6.1 Family Name

PID.6.1.1 Surname Acosta Test Case Fixed

PID.6.1.2 Own Surname Prefix

PID.6.1.3 Own Surname

PID.6.1.4 Surname Prefix From Partner/Spouse

PID.6.1.5 Surname From Partner/Spouse

PID.6.7 Name Type Code M Test Case Fixed

PID.7 Date/Time of Birth

PID.7.1 Time 200912231105 Test Case Fixed

PID.8 Administrative Sex F Test Case Fixed

PID.10 Race

PID.10.1 Identifier 2106-3 Test Case Fixed

PID.10.2 Text White Test Case Fixed

PID.10.3 Name of Coding System HL70005 Test Case Fixed

PID.10.5 Alternate Text

PID.10.6 Name of Alternate Coding System

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford Test Case Fixed

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06903 Test Case Fixed

PID.11.6 Country USA Test Case Fixed

PID.11.7 Address Type L Test Case Fixed

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 325 Shorline Drive

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06901

PID.11.6 Country

PID.11.7 Address Type BDL Test Case Fixed

PID.13 Phone Number - Home

PID.13.2 Telecommunication Use Code PRN Test Case Fixed

PID.13.3 Telecommunication Equipment Type PH Test Case Fixed

PID.13.4 Email Address

PID.13.6 Area/City Code 203 Test Case Fixed

PID.13.7 Local Number 5551212 Test Case Fixed

PID.22 Ethnic Group

PID.22.1 Identifier 2135-2 Test Case Fixed

PID.22.2 Text Hispanic or Latino Test Case Fixed

PID.22.3 Name of Coding System CDCREC Test Case Fixed

PID.22.5 Alternate Text

PID.22.6 Name of Alternate Coding System

PID.24 Multiple Birth Indicator

PID.25 Birth Order

PID.29 Patient Death Date and Time

PID.29.1 Time

PID.30 Patient Death Indicator

PD1 : Patient Additional Demographic

Location Data Element Data Categorization

PD1.11 Publicity Code

PD1.11.1 Identifier 02

PD1.11.2 Text Reminder/Recall - any method

PD1.11.3 Name of Coding System HL70215

PD1.11.5 Alternate Text

PD1.11.6 Name of Alternate Coding System

PD1.12 Protection Indicator

PD1.13 Protection Indicator Effective Date

PD1.16 Immunization Registry Status A

PD1.17 Immunization Registry Status Effective Date 20120701

PD1.18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties

Location Data Element Data Categorization

NK1.1 Set ID - NK1 1

NK1.2 Name

NK1.2.1 Family Name

NK1.2.1.1 Surname Gonzales

NK1.2.1.2 Own Surname Prefix

NK1.2.1.3 Own Surname

NK1.2.1.4 Surname Prefix From Partner/Spouse

NK1.2.1.5 Surname From Partner/Spouse

NK1.2.2 Given Name Joanna Test Case Fixed

NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed

NK1.2.7 Name Type Code L Test Case Fixed

NK1.3 Relationship

NK1.3.1 Identifier GRP Test Case Fixed

NK1.3.2 Text Grandparent Test Case Fixed

NK1.3.3 Name of Coding System HL70063 Test Case Fixed

NK1.3.5 Alternate Text

NK1.3.6 Name of Alternate Coding System

NK1.4 Address

NK1.4.1 Street Address

NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed

NK1.4.1.2 Street Name

NK1.4.1.3 Dwelling Number

NK1.4.2 Other Designation

NK1.4.3 City Stamford Test Case Fixed

NK1.4.4 State or Province CT Test Case Fixed

NK1.4.5 Zip or Postal Code 06901 Test Case Fixed

NK1.4.6 Country

NK1.4.7 Address Type L Test Case Fixed

NK1.5 Phone Number

NK1.5.2 Telecommunication Use Code PRN Test Case Fixed

NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed

NK1.5.4 Email Address

NK1.5.6 Area/City Code 203 Test Case Fixed

NK1.5.7 Local Number 5551212 Test Case Fixed

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Sirtis

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Lisa

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Carter

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Jane

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SH

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Ricci

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Gina

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Herrera

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Carlos

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name F

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20091123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Sirtis

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Lisa

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6332FK33

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101214

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100115

RXA.5 Administered Code

RXA.5.1 Identifier 45

RXA.5.2 Text hepatitis B vaccine, unspecified formulation

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 01

RXA.9.2 Text Historical Immunization

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6352FK1

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101001

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101030

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6352FK24

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120831

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 107

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2341

RXA.16 Substance Expiration Date

RXA.16.1 Time 20111130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2433

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110904

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS3255

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101201

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS249

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110301

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20140831

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 02

RXA.9.2 Text Historical information - from other provider

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Casera

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Linda

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D643QS8243

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140901

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M54K9245

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100324

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M55K3342

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101030

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M75K4566

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100523

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M53K5534

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110222

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV2431

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101004

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV4344

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100323

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 02

RXA.9.2 Text Historical information - from other provider

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Casera

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Linda

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D335PV9644

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110222

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150519

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text poliovirus vaccine, inactivated

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier 00

RXA.18.2 Text Parental decision

RXA.18.3 Name of Coding System NIP002

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status RE

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100121

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P243V3281

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P343V8321

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100330

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100522

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V2164

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100830

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20110221

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V58532

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110418

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV533

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100323

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text rotavirus, live, monovalent vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV932

RXA.16 Substance Expiration Date

RXA.16.1 Time 20100510

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20100925

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8734

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101027

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8734

RXA.16 Substance Expiration Date

RXA.16.1 Time 20110312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111002

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D9334IN9333

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120522

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131015

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 03

RXA.9.2 Text Historical information - from parents written record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Ricci

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Gina

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 8L4B3423

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140701

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MED

RXA.17.2 Text MedImmune, LLC

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 149

RXA.5.2 Text influenza, live, intranasal, quadrivalent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FluMist Quadrivalent

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.2

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text New immunization record

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 8L4B3521

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150815

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MED

RXA.17.2 Text MedImmune,LLC

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121104

RXA.5 Administered Code

RXA.5.1 Identifier 149

RXA.5.2 Text influenza, live, intranasal, quadrivalent

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FluMist Quadrivalent

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D9553IN2243

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120430

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT33

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120124

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120523

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT48

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120911

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20101023

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 01

RXA.9.2 Text historical

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W27V7491

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W87V3452

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130413

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp \T\ Dohme Corp

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 94 Test Case Fixed

RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text ProQuad Test Case Fixed

RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed

RXA.6 Administered Amount 0.5 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier mL Test Case Fixed

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM Test Case Fixed

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00 Test Case Fixed

RXA.9.2 Text New immunization record Test Case Fixed

RXA.9.3 Name of Coding System NIP001 Test Case Fixed

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina Test Case Fixed

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra Test Case Fixed

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150715 Test Case Fixed

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD Test Case Fixed

RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed

RXA.17.3 Name of Coding System MVX Test Case Fixed

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP Test Case Fixed

RXA.21 Action Code - RXA A

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38284

RXR.1.2 Text Nasal

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Nasal

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier BN

RXR.2.2 Text Bilateral Nares

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38284

RXR.1.2 Text Nasal

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Nasal

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier BN

RXR.2.2 Text Bilateral Nares

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299

RXR.1.2 Text Subcutaneous

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text Subcutaneous

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C38299 Test Case Fixed

RXR.1.2 Text Subcutaneous Test Case Fixed

RXR.1.3 Name of Coding System NCIT Test Case Fixed

RXR.1.5 Alternate Text Subcutaneous Test Case Fixed

RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed

RXR.2 Administration Site

RXR.2.1 Identifier LD Test Case Fixed

RXR.2.2 Text Left Deltoid Test Case Fixed

RXR.2.3 Name of Coding System HL70163 Test Case Fixed

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 21

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 31044-1

OBX.3.2 Text Reaction

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC12

OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20100522

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20140819

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS Presentation Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7

OBX.3.2 Text vaccine fund pgm elig cat

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier V01

OBX.5.2 Text Not VFC elig

OBX.5.3 Name of Coding System HL70064

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20100521

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS Presentation Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7

OBX.3.2 Text vaccine fund pgm elig cat

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier V01

OBX.5.2 Text Not VFC elig

OBX.5.3 Name of Coding System HL70064

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7

OBX.3.2 Text vaccine fund pgm elig cat

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier V01

OBX.5.2 Text Not VFC elig

OBX.5.3 Name of Coding System HL70064

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 21

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 31044-1 Test Case Fixed

OBX.3.2 Text Reaction Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC9

OBX.5.2 Text persistent, inconsolable crying lasting > 3 hours within 48 hours of dose

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information

Element Data

Patient Name Juana Mariana Gonzales

Mother's Maiden Name Maria Acosta

ID Number 123456 987633

Date/Time of Birth 12/23/2009

Administrative Sex Female

Patient Address 4345 Standish Way Stamford CT 06903 USA

Patient Address 1 325 Shorline Drive Stamford CT 06901

Local Number (203)555-1212

Race White

Ethnic Group Hispanic or Latino

Birth Order

Immunization Registry Information

Element Data

Immunization Registry Status A

Immunization Registry Status Effective Date 07/01/2012

Publicity Code Reminder/Recall - any method

Publicity Code Effective Date 07/01/2012

Protection Indicator

Protection Indicator Effective Date

Guardian or Responsible Party

Element Data

Name Joanna Merida Gonzales

Relationship Grandparent

Address 4345 Standish Way Stamford CT 06901

Phone Number (203)555-1212

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage

Date/Time Start of Administration 11/23/2009

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider Lisa Sirtis

Substance Lot Number 6332FK33

Substance Expiration Date 12/14/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Shoreline Hospital

Entered By Lisa Sirtis

Ordered By Jane Carter

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, unspecified formulation

Date/Time Start of Administration 01/15/2010

Administered Amount 999

Administered Units

Administration Notes Historical Immunization

Administering Provider Sandra Molina

Substance Lot Number 6352FK1

Substance Expiration Date 10/01/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage

Date/Time Start of Administration 10/30/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6352FK24

Substance Expiration Date 08/31/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS2341

Substance Expiration Date 11/30/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS2433

Substance Expiration Date 09/04/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS3255

Substance Expiration Date 12/01/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Historical information - from public agency

Element Data

Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D409QS249

Substance Expiration Date 03/01/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis

Date/Time Start of Administration 08/31/2014

Administered Amount 999

Administered Units

Administration Notes Historical information - from other provider

Administering Provider Linda Casera

Substance Lot Number D643QS8243

Substance Expiration Date 09/01/2014

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By J Rodriguez

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M54K9245

Substance Expiration Date 03/24/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M55K3342

Substance Expiration Date 10/30/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M75K4566

Substance Expiration Date 05/23/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7M53K5534

Substance Expiration Date 02/22/2011

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D333PV2431

Substance Expiration Date 10/04/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D333PV4344

Substance Expiration Date 03/23/2010

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from other provider

Administering Provider Linda Casera

Substance Lot Number D335PV9644

Substance Expiration Date 02/22/2011

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By J Rodriguez

Vaccine Administration Information

Element Data

Administered Code poliovirus vaccine, inactivated

Date/Time Start of Administration 05/19/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason Parental decision

Completion Status RE

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 01/21/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P243V3281

Substance Expiration Date 01/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P343V8321

Substance Expiration Date 03/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 05/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P853V2164

Substance Expiration Date 08/30/2010

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code pneumococcal conjugate vaccine, 13 valent

Date/Time Start of Administration 02/21/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number P853V58532

Substance Expiration Date 04/18/2011

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code rotavirus, live, monovalent vaccine

Date/Time Start of Administration 01/22/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RV533

Substance Expiration Date 02/15/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code rotavirus, live, monovalent vaccine

Date/Time Start of Administration 03/23/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RV932

Substance Expiration Date 05/10/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 09/25/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D8043IN8734

Substance Expiration Date 03/12/2011

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/27/2010

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D8043IN8734

Substance Expiration Date 03/12/2011

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/02/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D9334IN9333

Substance Expiration Date 05/22/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric

Date/Time Start of Administration 10/15/2013

Administered Amount 999

Administered Units

Administration Notes Historical information - from parents written record

Administering Provider Gina Ricci

Substance Lot Number 8L4B3423

Substance Expiration Date 07/01/2014

Substance Manufacturer Name MedImmune, LLC

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Nasal

Administration Site Bilateral Nares

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Gina Ricci

Vaccine Administration Information

Element Data

Administered Code influenza, live, intranasal, quadrivalent

Date/Time Start of Administration 07/15/2015

Administered Amount 0.2

Administered Units

Administration Notes New immunization record

Administering Provider Sandra Molina

Substance Lot Number 8L4B3521

Substance Expiration Date 08/15/2015

Substance Manufacturer Name MedImmune,LLC

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Nasal

Administration Site Bilateral Nares

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Observations

Element Data

VIS Publication Date 08/19/2014

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information

Element Data

Administered Code influenza, live, intranasal, quadrivalent

Date/Time Start of Administration 11/04/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number D9553IN2243

Substance Expiration Date 04/30/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

Date/Time Start of Administration 11/23/2011

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RT33

Substance Expiration Date 01/24/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By Carlos Herrera

Vaccine Administration Information

Element Data

Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule

Date/Time Start of Administration 05/23/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 6359RT48

Substance Expiration Date 09/11/2012

Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 10/23/2010

Administered Amount 999

Administered Units

Administration Notes historical

Administering Provider J Martinez

Substance Lot Number 7W27V7491

Substance Expiration Date 12/15/2010

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 11/22/2012

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider J Martinez

Substance Lot Number 7W87V3452

Substance Expiration Date 04/13/2013

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J Martinez

Ordered By F Smith

Vaccine Administration Information

Element Data

Administered Code measles, mumps, rubella, and varicella virus vaccine

Date/Time Start of Administration 07/15/2015

Administered Amount 0.5

Administered Units

Administration Notes New immunization record

Administering Provider Sandra Molina

Substance Lot Number 7W87V3687

Substance Expiration Date 07/15/2015

Substance Manufacturer Name Merck Sharp \T\ Dohme Corp

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route Subcutaneous

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Observations

Element Data

VIS Publication Date 05/21/2010

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

vaccine fund pgm elig cat Not VFC elig

Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose

5.2. Juan Marcel Gonzales Transmit Immunization Report
Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juan Marcel Gonzales.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

5.2.1. Transmit the Immunization Report for Juan Marcel Gonzales
Test Step Type:
The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.
Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID Test EHR Application

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID X68

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID NIST Test Iz Reg

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20120701082240-0500

MSH.9 Message Type

MSH.9.1 Message Code VXU

MSH.9.2 Trigger Event V04

MSH.9.3 Message Structure VXU_V04

MSH.10 Message Control ID NIST-IZ-001.00

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z22

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Gonzales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Juan Test Case Fixed

PID.5.3 Second and Further Given Names or Initials Thereof Marcel Test Case Fixed

PID.5.7 Name Type Code L Test Case Fixed

PID.6 Mother's Maiden Name

PID.6.1 Family Name

PID.6.1.1 Surname Morales Test Case Fixed

PID.6.1.2 Own Surname Prefix

PID.6.1.3 Own Surname

PID.6.1.4 Surname Prefix From Partner/Spouse

PID.6.1.5 Surname From Partner/Spouse

PID.6.7 Name Type Code M Test Case Fixed

PID.7 Date/Time of Birth

PID.7.1 Time 201111231100 Test Case Fixed

PID.8 Administrative Sex M Test Case Fixed

PID.10 Race

PID.10.1 Identifier 2106-3 Test Case Fixed

PID.10.2 Text White Test Case Fixed

PID.10.3 Name of Coding System HL70005 Test Case Fixed

PID.10.5 Alternate Text

PID.10.6 Name of Alternate Coding System

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 4623 Standish Way Test Case Fixed

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford Test Case Fixed

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06903 Test Case Fixed

PID.11.6 Country USA Test Case Fixed

PID.11.7 Address Type L Test Case Fixed

PID.13 Phone Number - Home

PID.13.2 Telecommunication Use Code PRN Test Case Fixed

PID.13.3 Telecommunication Equipment Type PH Test Case Fixed

PID.13.4 Email Address

PID.13.6 Area/City Code 203 Test Case Fixed

PID.13.7 Local Number 5551213 Test Case Fixed

PID.22 Ethnic Group

PID.22.1 Identifier 2135-2 Test Case Fixed

PID.22.2 Text Hispanic or Latino Test Case Fixed

PID.22.3 Name of Coding System CDCREC Test Case Fixed

PID.22.5 Alternate Text

PID.22.6 Name of Alternate Coding System

PID.24 Multiple Birth Indicator

PID.25 Birth Order

PID.29 Patient Death Date and Time

PID.29.1 Time

PID.30 Patient Death Indicator

PD1 : Patient Additional Demographic

Location Data Element Data Categorization

PD1.11 Publicity Code

PD1.11.1 Identifier 02

PD1.11.2 Text Reminder/Recall - any method

PD1.11.3 Name of Coding System HL70215

PD1.11.5 Alternate Text

PD1.11.6 Name of Alternate Coding System

PD1.12 Protection Indicator

PD1.13 Protection Indicator Effective Date

PD1.16 Immunization Registry Status A

PD1.17 Immunization Registry Status Effective Date 20120701

PD1.18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties

Location Data Element Data Categorization

NK1.1 Set ID - NK1 1

NK1.2 Name

NK1.2.1 Family Name

NK1.2.1.1 Surname Gonzales Test Case Fixed

NK1.2.1.2 Own Surname Prefix

NK1.2.1.3 Own Surname

NK1.2.1.4 Surname Prefix From Partner/Spouse

NK1.2.1.5 Surname From Partner/Spouse

NK1.2.2 Given Name Manuel Test Case Fixed

NK1.2.3 Second and Further Given Names or Initials Thereof Marcel Test Case Fixed

NK1.2.7 Name Type Code L Test Case Fixed

NK1.3 Relationship

NK1.3.1 Identifier FTH Test Case Fixed

NK1.3.2 Text Father Test Case Fixed

NK1.3.3 Name of Coding System HL70063 Test Case Fixed

NK1.3.5 Alternate Text

NK1.3.6 Name of Alternate Coding System

NK1.4 Address

NK1.4.1 Street Address

NK1.4.1.1 Street or Mailing Address 4623 Standish Way Test Case Fixed

NK1.4.1.2 Street Name

NK1.4.1.3 Dwelling Number

NK1.4.2 Other Designation

NK1.4.3 City Stamford Test Case Fixed

NK1.4.4 State or Province CT Test Case Fixed

NK1.4.5 Zip or Postal Code 06903 Test Case Fixed

NK1.4.6 Country

NK1.4.7 Address Type L

NK1.5 Phone Number

NK1.5.2 Telecommunication Use Code PRN Test Case Fixed

NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed

NK1.5.4 Email Address

NK1.5.6 Area/City Code 203 Test Case Fixed

NK1.5.7 Local Number 5551213 Test Case Fixed

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Sirtis

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Lisa

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Carter

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Jane

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SH

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Martinez

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name J.

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Rodriguez

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name J.

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier OP

ORC.17.2 Text Oceanview Pediatrics

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111123

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6332FK34

RXA.16 Substance Expiration Date

RXA.16.1 Time 20111214

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20111223

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6352FK2

RXA.16 Substance Expiration Date

RXA.16.1 Time 20111001

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text Hepatitis B

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.5

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6332FK26

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150825

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2342

RXA.16 Substance Expiration Date

RXA.16.1 Time 20121130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS2434

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120904

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS250

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140103

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130220

RXA.5 Administered Code

RXA.5.1 Identifier 106

RXA.5.2 Text DTaP

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text DAPTACEL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D409QS250

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140103

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M54K9255

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120324

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp and Dohme Corp.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M55K3343

RXA.16 Substance Expiration Date

RXA.16.1 Time 20121030

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp and Dohme Corp.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120512

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M75K4577

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120523

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp and Dohme Corp.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120222

RXA.5 Administered Code

RXA.5.1 Identifier 49

RXA.5.2 Text Hib

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PedvaxHIB

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7M53K5535

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120222

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp and Dohme Corp.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV2444

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120410

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text MSanofi Pasteur Inc.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV4343

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120323

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text MSanofi Pasteur Inc.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 10

RXA.5.2 Text Polio (IPV)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text IPOL

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D333PV4343

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120323

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text MSanofi Pasteur Inc.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P243V3321

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120130

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P343V8445

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120330

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120521

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V2175

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120830

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 133

RXA.5.2 Text Pneumococcal conjugate (PCV13)

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text PREVNAR 13

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number P853V58544

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130118

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PFR

RXA.17.2 Text Pfizer, Inc

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121122

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV543

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120322

RXA.5 Administered Code

RXA.5.1 Identifier 119

RXA.5.2 Text Rotavirus

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ROTARIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RV933

RXA.16 Substance Expiration Date

RXA.16.1 Time 20120510

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20120922

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8738

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20121022

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8798

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130312

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131030

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D9334IN9433

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140522

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 161

RXA.5.2 Text Influenza

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text FLUZONE QUADRIVALENT

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 0.25

RXA.7 Administered Units

RXA.7.1 Identifier mL

RXA.7.2 Text

RXA.7.3 Name of Coding System UCUM

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 00

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Molina

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Sandra

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number D8043IN8855

RXA.16 Substance Expiration Date

RXA.16.1 Time 20150828

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier PMC

RXA.17.2 Text Sanofi Pasteur

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130521

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT35

RXA.16 Substance Expiration Date

RXA.16.1 Time 20140104

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20131201

RXA.5 Administered Code

RXA.5.1 Identifier 83

RXA.5.2 Text Hepatitis A

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text HAVRIX

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6359RT47

RXA.16 Substance Expiration Date

RXA.16.1 Time 20130911

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20130112

RXA.5 Administered Code

RXA.5.1 Identifier 94

RXA.5.2 Text MMR and Varicella

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ProQuad

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Martinez

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name J.

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 7W27V7632

RXA.16 Substance Expiration Date

RXA.16.1 Time 20161215

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier MSD

RXA.17.2 Text Merck Sharp and Dohme Corp.

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXR[]
RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Thigh Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RT

RXR.2.2 Text Right Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier RD

RXR.2.2 Text Right Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LD

RXR.2.2 Text Left Deltoid

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text SC

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text SC

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20120202

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS Presentation Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7

OBX.3.2 Text vaccine fund pgm elig cat

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29768-9

OBX.3.2 Text VIS Publication Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20140819

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 29769-7

OBX.3.2 Text VIS Presentation Date

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 64994-7

OBX.3.2 Text vaccine fund pgm elig cat

OBX.3.3 Name of Coding System LN

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information

Element Data

Patient Name Juan Marcel Gonzales

Mother's Maiden Name Anita Morales

ID Number 123456 987633

Date/Time of Birth 11/23/2011

Administrative Sex Male

Patient Address 4623 Standish Way Stamford CT 06903 USA

Local Number (203)555-1213

Race White

Ethnic Group Hispanic or Latino

Birth Order

Immunization Registry Information

Element Data

Immunization Registry Status A

Immunization Registry Status Effective Date 07/01/2012

Publicity Code Reminder/Recall - any method

Publicity Code Effective Date 07/01/2012

Protection Indicator

Protection Indicator Effective Date

Guardian or Responsible Party

Element Data

Name Manuel Marcel Gonzales

Relationship Father

Address 4623 Standish Way Stamford CT 06903

Phone Number (203)555-1213

Vaccine Administration Information

Element Data

Administered Code Hepatitis B

Date/Time Start of Administration 11/23/2011

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6332FK34

Substance Expiration Date 12/14/2011

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Shoreline Hospital

Entered By Lisa Sirtis

Ordered By Jane Carter

Vaccine Administration Information

Element Data

Administered Code Hepatitis B

Date/Time Start of Administration 12/23/2011

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6352FK2

Substance Expiration Date 10/01/2011

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hepatitis B

Date/Time Start of Administration 07/15/2015

Administered Amount 0.5

Administered Units

Administration Notes

Administering Provider Sandra Molina

Substance Lot Number 6332FK26

Substance Expiration Date 08/25/2015

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

VIS Publication Date 02/02/2012

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information

Element Data

Administered Code DTaP

Date/Time Start of Administration 01/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D409QS2342

Substance Expiration Date 11/30/2012

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code DTaP

Date/Time Start of Administration 03/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D409QS2434

Substance Expiration Date 09/04/2012

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code DTaP

Date/Time Start of Administration 05/21/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D409QS250

Substance Expiration Date 01/03/2014

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code DTaP

Date/Time Start of Administration 02/20/2013

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D409QS250

Substance Expiration Date 01/03/2014

Substance Manufacturer Name Sanofi Pasteur Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hib

Date/Time Start of Administration 01/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 7M54K9255

Substance Expiration Date 03/24/2012

Substance Manufacturer Name Merck Sharp and Dohme Corp.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hib

Date/Time Start of Administration 03/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 7M55K3343

Substance Expiration Date 10/30/2012

Substance Manufacturer Name Merck Sharp and Dohme Corp.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hib

Date/Time Start of Administration 05/12/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 7M75K4577

Substance Expiration Date 05/23/2012

Substance Manufacturer Name Merck Sharp and Dohme Corp.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hib

Date/Time Start of Administration 02/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 7M53K5535

Substance Expiration Date 02/22/2012

Substance Manufacturer Name Merck Sharp and Dohme Corp.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Polio (IPV)

Date/Time Start of Administration 01/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D333PV2444

Substance Expiration Date 04/10/2012

Substance Manufacturer Name MSanofi Pasteur Inc.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Polio (IPV)

Date/Time Start of Administration 03/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D333PV4343

Substance Expiration Date 03/23/2012

Substance Manufacturer Name MSanofi Pasteur Inc.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Polio (IPV)

Date/Time Start of Administration 05/21/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D333PV4343

Substance Expiration Date 03/23/2012

Substance Manufacturer Name MSanofi Pasteur Inc.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Pneumococcal conjugate (PCV13)

Date/Time Start of Administration 01/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number P243V3321

Substance Expiration Date 01/30/2012

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Pneumococcal conjugate (PCV13)

Date/Time Start of Administration 03/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number P343V8445

Substance Expiration Date 03/30/2012

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Pneumococcal conjugate (PCV13)

Date/Time Start of Administration 05/21/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number P853V2175

Substance Expiration Date 08/30/2012

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Pneumococcal conjugate (PCV13)

Date/Time Start of Administration 11/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number P853V58544

Substance Expiration Date 01/18/2013

Substance Manufacturer Name Pfizer, Inc

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Rotavirus

Date/Time Start of Administration 11/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6359RV543

Substance Expiration Date 02/15/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Rotavirus

Date/Time Start of Administration 03/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6359RV933

Substance Expiration Date 05/10/2012

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Thigh Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Influenza

Date/Time Start of Administration 09/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D8043IN8738

Substance Expiration Date 03/12/2013

Substance Manufacturer Name Sanofi Pasteur

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Influenza

Date/Time Start of Administration 10/22/2012

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D8043IN8798

Substance Expiration Date 03/12/2013

Substance Manufacturer Name Sanofi Pasteur

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Influenza

Date/Time Start of Administration 10/30/2013

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number D9334IN9433

Substance Expiration Date 05/22/2014

Substance Manufacturer Name Sanofi Pasteur

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Influenza

Date/Time Start of Administration 07/15/2015

Administered Amount 0.25

Administered Units

Administration Notes

Administering Provider Sandra Molina

Substance Lot Number D8043IN8855

Substance Expiration Date 08/28/2015

Substance Manufacturer Name Sanofi Pasteur

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

VIS Publication Date 08/19/2014

VIS Presentation Date 07/15/2015

vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information

Element Data

Administered Code Hepatitis A

Date/Time Start of Administration 05/21/2013

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6359RT35

Substance Expiration Date 01/04/2014

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Right Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code Hepatitis A

Date/Time Start of Administration 12/01/2013

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 6359RT47

Substance Expiration Date 09/11/2013

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Deltoid

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

Vaccine Administration Information

Element Data

Administered Code MMR and Varicella

Date/Time Start of Administration 01/12/2013

Administered Amount 999

Administered Units

Administration Notes

Administering Provider J. Martinez

Substance Lot Number 7W27V7632

Substance Expiration Date 12/15/2016

Substance Manufacturer Name Merck Sharp and Dohme Corp.

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route SC

Administration Site Left Thigh

Entering Organization Oceanview Pediatrics

Entered By J. Martinez

Ordered By J. Rodriguez

5.3. Mariela Gonzales Morales Transmit Immunization Report
Send the Immunization Report to the Immunization Registry (VXU/Z22) for Mariela Gonzales Morales.
Test Story

Description

No Description

Comments

No Comments

PreCondition

No PreCondition

PostCondition

No PostCondition

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

5.3.1. Transmit the Immunization Report for Mariela Gonzales Morales
Test Step Type:
The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes the vaccine deferral and may include historical information updated in the EMR during the visit.
Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all vaccine deferrals recorded in the EMR in any order. The report may include the information imported from the IIS

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EMR. Current Date is expected for the Non-Administration date and deferral date.

Notes to Testers

No Note

Message Contents

MSH : Message Header

Location Data Element Data Categorization

MSH.1 Field Separator |

MSH.2 Encoding Characters ^~\&

MSH.3 Sending Application

MSH.3.1 Namespace ID Test EHR Application

MSH.3.2 Universal ID

MSH.3.3 Universal ID Type

MSH.4 Sending Facility

MSH.4.1 Namespace ID X68

MSH.4.2 Universal ID

MSH.4.3 Universal ID Type

MSH.5 Receiving Application

MSH.5.1 Namespace ID

MSH.5.2 Universal ID

MSH.5.3 Universal ID Type

MSH.6 Receiving Facility

MSH.6.1 Namespace ID NIST Test Iz Reg

MSH.6.2 Universal ID

MSH.6.3 Universal ID Type

MSH.7 Date/Time Of Message

MSH.7.1 Time 20120701082240-0500

MSH.9 Message Type

MSH.9.1 Message Code VXU

MSH.9.2 Trigger Event V04

MSH.9.3 Message Structure VXU_V04

MSH.10 Message Control ID NIST-IZ-001.00

MSH.11 Processing ID

MSH.11.1 Processing ID P

MSH.12 Version ID

MSH.12.1 Version ID 2.5.1

MSH.15 Accept Acknowledgment Type ER

MSH.16 Application Acknowledgment Type AL

MSH.21 Message Profile Identifier

MSH.21.1 Entity Identifier Z22

MSH.21.2 Namespace ID CDCPHINVS

MSH.21.3 Universal ID

MSH.21.4 Universal ID Type

MSH.22 Sending Responsible Organization

MSH.22.1 Organization Name

MSH.22.6 Assigning Authority

MSH.22.6.1 Namespace ID

MSH.22.6.2 Universal ID

MSH.22.6.3 Universal ID Type

MSH.22.7 Identifier Type Code

MSH.22.10 Organization Identifier

MSH.23 Receiving Responsible Organization

MSH.23.1 Organization Name

MSH.23.6 Assigning Authority

MSH.23.6.1 Namespace ID

MSH.23.6.2 Universal ID

MSH.23.6.3 Universal ID Type

MSH.23.7 Identifier Type Code

MSH.23.10 Organization Identifier

PID : Patient Identification

Location Data Element Data Categorization

PID.1 Set ID - PID 1

PID.3 Patient Identifier List

PID.3.1 ID Number 123456

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYEHR

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code MR

PID.3 Patient Identifier List

PID.3.1 ID Number 987633

PID.3.3 Check Digit Scheme

PID.3.4 Assigning Authority

PID.3.4.1 Namespace ID MYIIS

PID.3.4.2 Universal ID

PID.3.4.3 Universal ID Type

PID.3.5 Identifier Type Code SR

PID.5 Patient Name

PID.5.1 Family Name

PID.5.1.1 Surname Morales

PID.5.1.2 Own Surname Prefix

PID.5.1.3 Own Surname

PID.5.1.4 Surname Prefix From Partner/Spouse

PID.5.1.5 Surname From Partner/Spouse

PID.5.2 Given Name Mariela Test Case Fixed

PID.5.3 Second and Further Given Names or Initials Thereof Gonzales Test Case Fixed

PID.5.7 Name Type Code L Test Case Fixed

PID.6 Mother's Maiden Name

PID.6.1 Family Name

PID.6.1.1 Surname Gonzales Test Case Fixed

PID.6.1.2 Own Surname Prefix

PID.6.1.3 Own Surname

PID.6.1.4 Surname Prefix From Partner/Spouse

PID.6.1.5 Surname From Partner/Spouse

PID.6.7 Name Type Code M Test Case Fixed

PID.7 Date/Time of Birth

PID.7.1 Time 201505301115 Test Case Fixed

PID.8 Administrative Sex F Test Case Fixed

PID.10 Race

PID.10.1 Identifier 2106-3 Test Case Fixed

PID.10.2 Text White Test Case Fixed

PID.10.3 Name of Coding System HL70005 Test Case Fixed

PID.10.5 Alternate Text

PID.10.6 Name of Alternate Coding System

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 3321 Standish Way Test Case Fixed

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford Test Case Fixed

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06903 Test Case Fixed

PID.11.6 Country USA Test Case Fixed

PID.11.7 Address Type L Test Case Fixed

PID.11 Patient Address

PID.11.1 Street Address

PID.11.1.1 Street or Mailing Address 325 Shorline Drive

PID.11.1.2 Street Name

PID.11.1.3 Dwelling Number

PID.11.2 Other Designation

PID.11.3 City Stamford

PID.11.4 State or Province CT Test Case Fixed

PID.11.5 Zip or Postal Code 06901

PID.11.6 Country

PID.11.7 Address Type BDL Test Case Fixed

PID.13 Phone Number - Home

PID.13.2 Telecommunication Use Code PRN Test Case Fixed

PID.13.3 Telecommunication Equipment Type PH Test Case Fixed

PID.13.4 Email Address

PID.13.6 Area/City Code 203 Test Case Fixed

PID.13.7 Local Number 5551214 Test Case Fixed

PID.22 Ethnic Group

PID.22.1 Identifier 2135-2 Test Case Fixed

PID.22.2 Text Hispanic or Latino Test Case Fixed

PID.22.3 Name of Coding System CDCREC Test Case Fixed

PID.22.5 Alternate Text

PID.22.6 Name of Alternate Coding System

PID.24 Multiple Birth Indicator

PID.25 Birth Order

PID.29 Patient Death Date and Time

PID.29.1 Time

PID.30 Patient Death Indicator

PD1 : Patient Additional Demographic

Location Data Element Data Categorization

PD1.11 Publicity Code

PD1.11.1 Identifier 02

PD1.11.2 Text Reminder/Recall - any method

PD1.11.3 Name of Coding System HL70215

PD1.11.5 Alternate Text

PD1.11.6 Name of Alternate Coding System

PD1.12 Protection Indicator

PD1.13 Protection Indicator Effective Date

PD1.16 Immunization Registry Status A

PD1.17 Immunization Registry Status Effective Date 20120701

PD1.18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties

Location Data Element Data Categorization

NK1.1 Set ID - NK1 1

NK1.2 Name

NK1.2.1 Family Name

NK1.2.1.1 Surname Morales Test Case Fixed

NK1.2.1.2 Own Surname Prefix

NK1.2.1.3 Own Surname

NK1.2.1.4 Surname Prefix From Partner/Spouse

NK1.2.1.5 Surname From Partner/Spouse

NK1.2.2 Given Name Joanna Test Case Fixed

NK1.2.3 Second and Further Given Names or Initials Thereof Gonzales Test Case Fixed

NK1.2.7 Name Type Code L Test Case Fixed

NK1.3 Relationship

NK1.3.1 Identifier MTH Test Case Fixed

NK1.3.2 Text Mother Test Case Fixed

NK1.3.3 Name of Coding System HL70063

NK1.3.5 Alternate Text

NK1.3.6 Name of Alternate Coding System

NK1.4 Address

NK1.4.1 Street Address

NK1.4.1.1 Street or Mailing Address 4623 Standish Way Test Case Fixed

NK1.4.1.2 Street Name

NK1.4.1.3 Dwelling Number

NK1.4.2 Other Designation

NK1.4.3 City Stamford Test Case Fixed

NK1.4.4 State or Province CT Test Case Fixed

NK1.4.5 Zip or Postal Code 06903 Test Case Fixed

NK1.4.6 Country

NK1.4.7 Address Type L Test Case Fixed

NK1.5 Phone Number

NK1.5.2 Telecommunication Use Code PRN Test Case Fixed

NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed

NK1.5.4 Email Address

NK1.5.6 Area/City Code 203 Test Case Fixed

NK1.5.7 Local Number 5551213 Test Case Fixed

ORC[]
ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 197027

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Sirtis Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Lisa

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Carter

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Jane

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SH

ORC.17.2 Text Shoreline Hospital

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L Test Case Fixed

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

ORC : Common Order

Location Data Element Data Categorization

ORC.1 Order Control RE

ORC.2 Placer Order Number

ORC.2.1 Entity Identifier

ORC.2.2 Namespace ID

ORC.2.3 Universal ID

ORC.2.4 Universal ID Type

ORC.3 Filler Order Number

ORC.3.1 Entity Identifier 9999

ORC.3.2 Namespace ID DCS

ORC.3.3 Universal ID

ORC.3.4 Universal ID Type

ORC.10 Entered By

ORC.10.1 ID Number

ORC.10.2 Family Name

ORC.10.2.1 Surname Molina Test Case Fixed

ORC.10.2.2 Own Surname Prefix

ORC.10.2.3 Own Surname

ORC.10.2.4 Surname Prefix From Partner/Spouse

ORC.10.2.5 Surname From Partner/Spouse

ORC.10.3 Given Name Sandra Test Case Fixed

ORC.10.4 Second and Further Given Names or Initials Thereof

ORC.10.9 Assigning Authority

ORC.10.9.1 Namespace ID

ORC.10.9.2 Universal ID

ORC.10.9.3 Universal ID Type

ORC.10.10 Name Type Code

ORC.10.12 Check Digit Scheme

ORC.10.13 Identifier Type Code

ORC.12 Ordering Provider

ORC.12.1 ID Number

ORC.12.2 Family Name

ORC.12.2.1 Surname Smith Test Case Fixed

ORC.12.2.2 Own Surname Prefix

ORC.12.2.3 Own Surname

ORC.12.2.4 Surname Prefix From Partner/Spouse

ORC.12.2.5 Surname From Partner/Spouse

ORC.12.3 Given Name Frank Test Case Fixed

ORC.12.4 Second and Further Given Names or Initials Thereof

ORC.12.9 Assigning Authority

ORC.12.9.1 Namespace ID

ORC.12.9.2 Universal ID

ORC.12.9.3 Universal ID Type

ORC.12.10 Name Type Code L

ORC.12.12 Check Digit Scheme

ORC.12.13 Identifier Type Code

ORC.17 Entering Organization

ORC.17.1 Identifier SP

ORC.17.2 Text Shoreline Pediatrics Test Case Fixed

ORC.17.3 Name of Coding System HL70362

ORC.17.5 Alternate Text

ORC.17.6 Name of Alternate Coding System

RXA[]
RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150530

RXA.5 Administered Code

RXA.5.1 Identifier 08

RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage

RXA.5.3 Name of Coding System CVX

RXA.5.5 Alternate Text ENGERIX-B

RXA.5.6 Name of Alternate Coding System NDC

RXA.6 Administered Amount 999

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier 08

RXA.9.2 Text Historical information - from public agency

RXA.9.3 Name of Coding System NIP001

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname Sirtis

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name Lisa

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID DCS_DC

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number 6332FK33

RXA.16 Substance Expiration Date

RXA.16.1 Time 20101214

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier SKB

RXA.17.2 Text GlaxoSmithKline Biologicals SA

RXA.17.3 Name of Coding System MVX

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status CP

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 45 Test Case Fixed

RXA.5.2 Text hepatitis B vaccine, unspecified formulation Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA Test Case Fixed

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 107 Test Case Fixed

RXA.5.2 Text DTaP, unspecified formulation Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA Test Case Fixed

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 08 Test Case Fixed

RXA.5.2 Text Hib Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA Test Case Fixed

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 152 Test Case Fixed

RXA.5.2 Text Pneumococcal Conjugate, unspecified formulation Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA Test Case Fixed

RXA.21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration

Location Data Element Data Categorization

RXA.1 Give Sub-ID Counter 0

RXA.2 Administration Sub-ID Counter 1

RXA.3 Date/Time Start of Administration

RXA.3.1 Time 20150715

RXA.5 Administered Code

RXA.5.1 Identifier 122 Test Case Fixed

RXA.5.2 Text rotavirus, unspecified formulation Test Case Fixed

RXA.5.3 Name of Coding System CVX Test Case Fixed

RXA.5.5 Alternate Text

RXA.5.6 Name of Alternate Coding System

RXA.6 Administered Amount 999 Test Case Fixed

RXA.7 Administered Units

RXA.7.1 Identifier

RXA.7.2 Text

RXA.7.3 Name of Coding System

RXA.7.5 Alternate Text

RXA.7.6 Name of Alternate Coding System

RXA.9 Administration Notes

RXA.9.1 Identifier

RXA.9.2 Text

RXA.9.3 Name of Coding System

RXA.9.5 Alternate Text

RXA.9.6 Name of Alternate Coding System

RXA.10 Administering Provider

RXA.10.1 ID Number

RXA.10.2 Family Name

RXA.10.2.1 Surname

RXA.10.2.2 Own Surname Prefix

RXA.10.2.3 Own Surname

RXA.10.2.4 Surname Prefix From Partner/Spouse

RXA.10.2.5 Surname From Partner/Spouse

RXA.10.3 Given Name

RXA.10.4 Second and Further Given Names or Initials Thereof

RXA.10.9 Assigning Authority

RXA.10.9.1 Namespace ID

RXA.10.9.2 Universal ID

RXA.10.9.3 Universal ID Type

RXA.10.10 Name Type Code

RXA.10.12 Check Digit Scheme

RXA.10.13 Identifier Type Code

RXA.11 Administered-at Location

RXA.11.4 Facility

RXA.11.4.1 Namespace ID

RXA.11.4.2 Universal ID

RXA.11.4.3 Universal ID Type

RXA.15 Substance Lot Number

RXA.16 Substance Expiration Date

RXA.16.1 Time

RXA.17 Substance Manufacturer Name

RXA.17.1 Identifier

RXA.17.2 Text

RXA.17.3 Name of Coding System

RXA.17.5 Alternate Text

RXA.17.6 Name of Alternate Coding System

RXA.18 Substance/Treatment Refusal Reason

RXA.18.1 Identifier

RXA.18.2 Text

RXA.18.3 Name of Coding System

RXA.18.5 Alternate Text

RXA.18.6 Name of Alternate Coding System

RXA.20 Completion Status NA Test Case Fixed

RXA.21 Action Code - RXA A

RXR : Pharmacy/Treatment Route

Location Data Element Data Categorization

RXR.1 Route

RXR.1.1 Identifier C28161

RXR.1.2 Text IM

RXR.1.3 Name of Coding System NCIT

RXR.1.5 Alternate Text IM

RXR.1.6 Name of Alternate Coding System HL70162

RXR.2 Administration Site

RXR.2.1 Identifier LT

RXR.2.2 Text Left Thigh

RXR.2.3 Name of Coding System HL70163

RXR.2.5 Alternate Text

RXR.2.6 Name of Alternate Coding System

OBX[]
OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30945-0 Test Case Fixed

OBX.3.2 Text Vaccination contraindication Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC23

OBX.5.2 Text current fever with moderate-to-severe illness

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30946-8 Test Case Fixed

OBX.3.2 Text Vaccination contraindication/precaution effective date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30944-3 Test Case Fixed

OBX.3.2 Text Vaccination temporary contraindication/precaution expiration date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150815

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30945-0 Test Case Fixed

OBX.3.2 Text Vaccination contraindication Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC23

OBX.5.2 Text current fever with moderate-to-severe illness

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30946-8 Test Case Fixed

OBX.3.2 Text Vaccination contraindication/precaution effective date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30944-3 Test Case Fixed

OBX.3.2 Text Vaccination temporary contraindication/precaution expiration date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150815

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30945-0 Test Case Fixed

OBX.3.2 Text Vaccination contraindication Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC23

OBX.5.2 Text current fever with moderate-to-severe illness

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30946-8 Test Case Fixed

OBX.3.2 Text Vaccination contraindication/precaution effective date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30944-3 Test Case Fixed

OBX.3.2 Text Vaccination temporary contraindication/precaution expiration date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150815

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30945-0 Test Case Fixed

OBX.3.2 Text Vaccination contraindication Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC23

OBX.5.2 Text current fever with moderate-to-severe illness

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30946-8 Test Case Fixed

OBX.3.2 Text Vaccination contraindication/precaution effective date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30944-3 Test Case Fixed

OBX.3.2 Text Vaccination temporary contraindication/precaution expiration date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150815

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 1

OBX.2 Value Type CE

OBX.3 Observation Identifier

OBX.3.1 Identifier 30945-0 Test Case Fixed

OBX.3.2 Text Vaccination contraindication Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Identifier VXC23

OBX.5.2 Text current fever with moderate-to-severe illness

OBX.5.3 Name of Coding System CDCPHINVS

OBX.5.5 Alternate Text

OBX.5.6 Name of Alternate Coding System

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 2

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30946-8 Test Case Fixed

OBX.3.2 Text Vaccination contraindication/precaution effective date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150715

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

OBX : Observation/Result

Location Data Element Data Categorization

OBX.1 Set ID - OBX 3

OBX.2 Value Type TS

OBX.3 Observation Identifier

OBX.3.1 Identifier 30944-3 Test Case Fixed

OBX.3.2 Text Vaccination temporary contraindication/precaution expiration date Test Case Fixed

OBX.3.3 Name of Coding System LN Test Case Fixed

OBX.3.5 Alternate Text

OBX.3.6 Name of Alternate Coding System

OBX.4 Observation Sub-ID 1

OBX.5 Observation Value

OBX.5.1 Time 20150815

OBX.6 Units

OBX.6.1 Identifier

OBX.6.2 Text

OBX.6.3 Name of Coding System

OBX.6.5 Alternate Text

OBX.6.6 Name of Alternate Coding System

OBX.11 Observation Result Status F

OBX.14 Date/Time of the Observation

OBX.14.1 Time 20150715

OBX.17 Observation Method

OBX.17.1 Identifier

OBX.17.2 Text

OBX.17.3 Name of Coding System

OBX.17.5 Alternate Text

OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information

Element Data

Patient Name Mariela Gonzales Morales

Mother's Maiden Name Joanna Gonzales

ID Number 123456 987633

Date/Time of Birth 05/30/2015

Administrative Sex Female

Patient Address 3321 Standish Way Stamford CT 06903 USA

Patient Address 1 325 Shorline Drive Stamford CT 06901

Local Number (203)555-1214

Race White

Ethnic Group Hispanic or Latino

Birth Order

Immunization Registry Information

Element Data

Immunization Registry Status A

Immunization Registry Status Effective Date 07/01/2012

Publicity Code Reminder/Recall - any method

Publicity Code Effective Date 07/01/2012

Protection Indicator

Protection Indicator Effective Date

Guardian or Responsible Party

Element Data

Name Joanna Gonzales Morales

Relationship Mother

Address 4623 Standish Way Stamford CT 06903

Phone Number (203)555-1213

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage

Date/Time Start of Administration 05/30/2015

Administered Amount 999

Administered Units

Administration Notes Historical information - from public agency

Administering Provider Lisa Sirtis

Substance Lot Number 6332FK33

Substance Expiration Date 12/14/2010

Substance Manufacturer Name GlaxoSmithKline Biologicals SA

Substance/Treatment Refusal Reason

Completion Status CP

Action Code Add

Route IM

Administration Site Left Thigh

Entering Organization Shoreline Hospital

Entered By Lisa Sirtis

Ordered By Jane Carter

Vaccine Administration Information

Element Data

Administered Code hepatitis B vaccine, unspecified formulation

Date/Time Start of Administration 07/15/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason

Completion Status NA

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

Vaccination contraindication current fever with moderate-to-severe illness

Vaccination contraindication/precaution effective date 07/15/2015

Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information

Element Data

Administered Code DTaP, unspecified formulation

Date/Time Start of Administration 07/15/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason

Completion Status NA

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

Vaccination contraindication current fever with moderate-to-severe illness

Vaccination contraindication/precaution effective date 07/15/2015

Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information

Element Data

Administered Code Hib

Date/Time Start of Administration 07/15/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason

Completion Status NA

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

Vaccination contraindication current fever with moderate-to-severe illness

Vaccination contraindication/precaution effective date 07/15/2015

Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information

Element Data

Administered Code Pneumococcal Conjugate, unspecified formulation

Date/Time Start of Administration 07/15/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason

Completion Status NA

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

Vaccination contraindication current fever with moderate-to-severe illness

Vaccination contraindication/precaution effective date 07/15/2015

Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information

Element Data

Administered Code rotavirus, unspecified formulation

Date/Time Start of Administration 07/15/2015

Administered Amount 999

Administered Units

Administration Notes

Administering Provider

Substance Lot Number

Substance Expiration Date

Substance Manufacturer Name

Substance/Treatment Refusal Reason

Completion Status NA

Action Code Add

Route

Administration Site

Entering Organization Shoreline Pediatrics

Entered By Sandra Molina

Ordered By Frank Smith

Element Data

Vaccination contraindication current fever with moderate-to-severe illness

Vaccination contraindication/precaution effective date 07/15/2015

Vaccination temporary contraindication/precaution expiration date 08/15/2015

6. Display Immunization Report
This test will consist of generating and displaying a human readable immunization report for the patient showing immunization history, upcoming vaccines due.
6.1. Juana Mariana Gonzales Display Immunization Report
Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

6.1.1. Produce an immunization report for Juana Mariana Gonzales including all history
Test Step Type: null
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report:* The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

The following patient demographics are displayed:

Patient Identifier Number:   Vendor Assigned

Patient Identifier Type Code: Vendor Assigned

Patient Name:   Juana Mariana Gonzales

Date/Time of Birth:   12/23/2009 11:05am

Sex: Female

Patient Address:   4345 Standish Way, Stamford, CT, 06903

Multiple Birth:   N

Birth Order:   NA

The following Vaccination History is displayed:

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 12/23/2009

Additional Observations: None

Dose #: 1

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Jane Carter

Entered By: Lisa Sirtis

Entering Organization: Shoreline Hospital

Administered Amt: .05 mL

Administering Provider: Jane Carter

Administered at Location: 325 Shorline Drive,

Stamford Connecticut 06901

Lot#: 6332FK33

Exp Date: 12/14/2010

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 1/15/2010

Additional Observations: None

Dose #: 2

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Frank Smith

Entered By: Sandra Molina

Entering Organization: Shoreline Pediatrics

Administered Amt: .05 mL

Administering Provider: Sandra Molina

Administered at Location: 400 Shorline Drive,

Stamford Connecticut 06901

Lot#: 6352FK1

Exp Date: 10/1/2010

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 10/30/2010

Additional Observations: None

Dose #: 3

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: Sandra Molina

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 6352FK24

Exp Date: 8/31/2012

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 1/22/2010

Additional Observations: None

Dose #: 1

Doses in Series: 5

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D409QS2341

Exp Date: 11/30/2011

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)

Date Administered: 3/23/2010

Additional Observations: 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose

Dose #: 2

Doses in Series: 5

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D409QS2433

Exp Date: 9/4/2011

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 5/22/2010

Additional Observations:

Dose #: 3

Doses in Series: 5

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D409QS3255

Exp Date: 12/1/2010

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 2/21/2011

Additional Observations:

Dose #: 4

Doses in Series: 5

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D409QS249

Exp Date: 3/1/2011

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 1/22/2010

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7M54K9245

Exp Date: 3/24/2010

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 3/23/2010

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7M55K3342

Exp Date: 10/30/2010

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 5/22/2010

Additional Observations:

Dose #: 3

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7M75K4566

Exp Date: 5/23/2010

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 2/21/2011

Additional Observations:

Dose #: 4

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7M53K5534

Exp Date: 2/22/2011

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated

Administered: poliovirus vaccine, inactivated (CVX 10)

IPOL (NDC 49281-0860-55)

Date Administered: 1/22/2010

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D333PV2431

Exp Date: 10/4/2010

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated

Administered: poliovirus vaccine, inactivated (CVX 10)

IPOL (NDC 49281-0860-55)

Date Administered: 3/23/2010

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D333PV4344

Exp Date: 3/23/2010

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 1/22/2010

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: P243V3281

Exp Date: 1/30/2010

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 3/23/2010

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: P343V8321

Exp Date: 3/30/2010

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 5/22/2010

Additional Observations:

Dose #: 3

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: P853V2164

Exp Date: 8/30/2010

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 2/21/2011

Additional Observations:

Dose #: 4

Doses in Series: 4

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: P853V58532

Exp Date: 4/18/2011

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: rotavirus, unspecified formulation

Administered: rotavirus, live, monovalent vaccine (CVX 119)

ROTARIX (NDC 58160-0854-52)"

Date Administered: 1/22/2010

Additional Observations:

Dose #: 1

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: 1 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 6359RV533

Exp Date: 2/15/2010

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: rotavirus, unspecified formulation

Administered: rotavirus, live, monovalent vaccine (CVX 119)

ROTARIX (NDC 58160-0854-52)"

Date Administered: 3/23/2010

Additional Observations:

Dose #: 2

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: 1 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 6359RV932

Exp Date: 5/10/2011

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 9/25/2010

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D8043IN8734

Exp Date: 3/12/2011

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 10/27/2010

Additional Observations:

Dose #: 2

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D8043IN8734

Exp Date: 3/12/2011

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 10/2/2011

Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D9334IN9333

Exp Date: 5/22/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 11/4/2012

Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: D9553IN2243

Exp Date: 4/30/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation

Administered: influenza, live, intranasal, quadrivalent (CVX 149)

FluMist Quadrivalent (NDC 66019-0301-10)"

Date Administered: Current Date

Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider: Sandra Molina

Entered By: Frank Smith

Entering Organization: Oceanview Pediatrics

Administered Amt: .2 mL

Administering Provider: Sandra Molina

Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901

Lot#: 8L4B3521

Exp Date: 7/15/2015

Manufacturer: MedImmune,LLC (MVX MED)

Route: Nasal (NCIT C38284), Nasal (HL70162 NS)

Site:

Vaccine Group: Hep A, unspecified formulation

Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)

HAVRIX (NDC 58160-0825-52)"

Date Administered: 11/23/2011

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 6359RT33

Exp Date: 1/4/2012

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Deltoid (HL7 RD)

Vaccine Group: Hep A, unspecified formulation

Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)

HAVRIX (NDC 58160-0825-52)"

Date Administered: 5/23/2012

Additional Observations:

Dose #: 2

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 6359RT48

Exp Date: 9/11/2012

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: MMRV

Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)

ProQuad (NDC 00006-4999-00)"

Date Administered: 10/23/2010

Additional Observations:

Dose #:

Doses in Series: 2

Valid Dose: N

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7W27V7491

Exp Date: 12/15/2010

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Thigh (HL7 LT)

Vaccine Group: MMRV

Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)

ProQuad (NDC 00006-4999-00)"

Date Administered: 11/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Carlos Herrera

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901

Lot#: 7W87V3452

Exp Date: 4/13/2013

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: MMRV

Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)

ProQuad (NDC 00006-4999-00)"

Date Administered: Current Date

Additional Observations: Reaction (LOINC 31044-1)/fever of >40.5C (105F) within 48 hours of dose (CDCPHINVS VXC12)

Dose #: 2

Doses in Series: 2

Valid Dose: Y

Ordering Provider: Sandra Molina

Entered By: Frank Smith

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: Sandra Molina

Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901

Lot#: 7W87V3687

Exp Date: 7/15/2015

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

The Following Vaccine Forecast is displayed:

Vaccine Group: IPV

Due Date: 11/22/2013

Earliest Date to Give: 11/22/2013

Latest Date to Give: 11/22/2015

Overdue Date: 11/23/2015

Immunization Schedule: ACIP

Vaccine Group: influenza, unspecified formulation

Due Date: 10/21/2016

Earliest Date to Give: 9/1/2016

Latest Date to Give: 2/29/2017

Overdue Date: 3/1/3027

Immunization Schedule: ACIP

Notes to Testers

No Note

6.2. Juan Marcel Gonzales Display Immunization Report
Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

6.2.1. Produce an immunization report for Juan Marcel Gonzales including all history
Test Step Type: null
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

The following patient demographics are displayed:

Patient Identifier Number: Vendor Assigned

Patient Identifier Type Code: Vendor Assigned

Patient Name: Juan Marcel Gonzales

Date/Time of Birth: 11/23/2011 11:00am

Sex: Male

Patient Address: 4623 Standish Way, Stamford, CT 06903

Multiple Birth: N

Birth Order: NA

The following Vaccination History is displayed:

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 11/23/2011

Additional Observations:

Dose #: 1

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Jane Carter

Entered By: Lisa Sirtis

Entering Organization: Shoreline Hospital

Administered Amt: .05 mL

Administering Provider: Jane Carter

Administered at Location: 325 Shorline Drive,

Stamford Connecticut 06901

Lot#: 6332FK34

Exp Date: 12/14/2011

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 12/23/2013

Additional Observations:

Dose #: 2

Doses in Series: 3

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 6352FK2

Exp Date: 10/1/2011

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: Current Date

Additional Observations:

Dose #: 3

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Sandra Molina

Entered By: Frank Smith

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: Sandra Molina

Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901

Lot#: 6332FK26

Exp Date: 8/25/2015

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL70162 LD)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 1/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 5

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D409QS2342

Exp Date: 11/30/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 3/22/2012

Additional Observations:

Dose #: 2

Doses in Series: 5

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D409QS2434

Exp Date: 9/4/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 5/21/2012

Additional Observations:

Dose #: 3

Doses in Series: 5

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D409QS3256

Exp Date: 12/1/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified

Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)

DAPTACEL (NDC 49281-0286-01)"

Date Administered: 5/21/2012

Additional Observations:

Dose #: 3

Doses in Series: 5

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D409QS3256

Exp Date: 12/1/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 1/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 7M54K9255

Exp Date: 3/24/2012

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 3/22/2012

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 7M55K3343

Exp Date: 10/30/2012

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 5/21/2012

Additional Observations:

Dose #: 3

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 7M75K4577

Exp Date: 5/23/2012

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: Hib, unspecified formulation

Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)

PedvaxHIB (NDC 00006-4897-00)"

Date Administered: 11/22/2012

Additional Observations:

Dose #: 4

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 7M53K5535

Exp Date: 2/22/2012

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated

Administered: poliovirus vaccine, inactivated (CVX 10)

IPOL (NDC 49281-0860-55)"

Date Administered: 1/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D333PV2444

Exp Date: 10/4/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated

Administered: poliovirus vaccine, inactivated (CVX 10)

IPOL (NDC 49281-0860-55)"

Date Administered: 3/22/2012

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D333PV4343

Exp Date: 3/23/2012

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: poliovirus vaccine, inactivated

Administered: poliovirus vaccine, inactivated (CVX 10)

IPOL (NDC 49281-0860-55)

Date Administered: 5/21/2012

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D335PV9654

Exp Date: 2/22/2013

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Deltoid (HL7 LD)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 1/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: P243V3321

Exp Date: 1/30/2012

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 3/22/2012

Additional Observations:

Dose #: 2

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: P343V8445

Exp Date: 3/30/2012

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 5/21/2012

Additional Observations:

Dose #: 3

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: P853V2175

Exp Date: 8/30/2012

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: pneumococcal, unspecified formulation

Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)

PREVNAR 13 (NDC 00005-1971-05)"

Date Administered: 11/22/2012

Additional Observations:

Dose #: 4

Doses in Series: 4

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: P853V58544

Exp Date: 4/18/2013

Manufacturer: Pfizer, Inc (MVX PFR)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: rotavirus, unspecified formulation

Administered: rotavirus, live, monovalent vaccine (CVX 119)

ROTARIX (NDC 58160-0854-52)"

Date Administered: 1/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 3

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: 1 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 6359RV533

Exp Date: 2/15/2010

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: rotavirus, unspecified formulation

Administered: rotavirus, live, monovalent vaccine (CVX 119)

ROTARIX (NDC 58160-0854-52)"

Date Administered: 3/22/2012

Additional Observations:

Dose #: 2

Doses in Series: 3

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: 1 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 6359RV932

Exp Date: 5/10/2011

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 9/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D8043IN8734

Exp Date: 3/12/2013

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 10/20/2012

Additional Observations:

Dose #: 2

Doses in Series: 2

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D8043IN8798

Exp Date: 3/12/2013

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Thigh (HL7 RT)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: 10/30/2013

Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: D8043IN8734

Exp Date: 5/22/2014

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: influenza, unspecified formulation

Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

FLUZONE QUADRIVALENT (NDC 49281-0514-25)"

Date Administered: Current Date

Additional Observations:

Dose #:

Doses in Series:

Valid Dose:

Ordering Provider: Sandra Molina

Entered By: Frank Smith

Entering Organization: Oceanview Pediatrics

Administered Amt: .25 mL

Administering Provider: Sandra Molina

Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901

Lot#: D8043IN8855

Exp Date: 7/28/2015

Manufacturer: Sanofi Pasteur Inc (MVX PMC)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

Vaccine Group: Hep A, unspecified formulation

Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)

HAVRIX (NDC 58160-0825-52)"

Date Administered: 5/21/2013

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 6359RT35

Exp Date: 1/4/2014

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Right Deltoid (HL7 RD)

Vaccine Group: Hep A, unspecified formulation

Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)

HAVRIX (NDC 58160-0825-52)"

Date Administered: 12/1/2013

Additional Observations:

Dose #: 2

Doses in Series: 2

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 6359RT47

Exp Date: 9/11/2013

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Deltoid (HL7 LD)

Vaccine Group: MMRV

Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)

ProQuad (NDC 00006-4999-00)"

Date Administered: 11/22/2012

Additional Observations:

Dose #: 1

Doses in Series: 2

Valid Dose: Y

Ordering Provider: J. Rodriguez

Entered By: J. Martinez

Entering Organization: Oceanview Pediatrics

Administered Amt: .05 mL

Administering Provider: J. Martinez

Administered at Location: 4253 Standish Way, Stamford Connecticut 06903

Lot#: 7W27V7632

Exp Date: 12/15/2016

Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)

Route: Subcutaneous (NCIT C38299, HL70162: SC)

Site: Left Thigh (HL7 LT)

The Following Vaccine Forecast is displayed:

Vaccine Group: Dtap

Due Date: 11/22/2015

Earliest Date to Give: 11/22/2015

Latest Date to Give: 11/21/2017

Overdue Date: 11/22/2017

Immunization Schedule: ACIP

Vaccine Group: IPV

Due Date: 11/22/2015

Earliest Date to Give: 11/22/2015

Latest Date to Give: 11/21/2017

Overdue Date: 11/22/2017

Immunization Schedule: ACIP

Vaccine Group: Influenza

Due Date: 10/22/2015

Earliest Date to Give: 9/1/2015

Latest Date to Give: 1/31/2016

Overdue Date: 2/1/2016

Immunization Schedule: ACIP

Vaccine Group: MMR

Due Date: 11/22/2015

Earliest Date to Give: 11/22/2015

Latest Date to Give: 11/21/2017

Overdue Date: 11/22/2017

Immunization Schedule: ACIP

Vaccine Group: Varicella

Due Date: 11/22/2015

Earliest Date to Give: 11/22/2015

Latest Date to Give: 11/21/2017

Overdue Date: 11/22/2017

Immunization Schedule: ACIP

Notes to Testers

No Note

6.3. Mariana Gonzales Morales Display Immunization Report
Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

6.3.1. Produce an immunization report for Juan Marcel Gonzales including all history
Test Step Type: null
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).
Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

The following patient demographics are displayed:

Patient Identifier Number: Vendor Supplied

Patient Identifier Type Code: Vendor Supplied

Patient Name: Mariela Gonzales Morales

Date/Time of Birth: 03/30/2015 11:00am

Sex: Female

Patient Address: 3321 Standish Way, Stamford, CT 06903

Multiple Birth: Y

Birth Order: 1

The following Vaccination History is displayed:

Vaccine Group: Hep B Peds NOS

Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)

ENGERIX-B (NDC 58160-0820-11)"

Date Administered: 11/23/2011

Additional Observations:

Dose #: 1

Doses in Series: 3

Valid Dose: Y

Ordering Provider: Jane Carter

Entered By: Lisa Sirtis

Entering Organization: Shoreline Hospital

Administered Amt: .05 mL

Administering Provider: Jane Carter

Administered at Location: 325 Shorline Drive,

Stamford Connecticut 06901

Lot#: 6332FK34

Exp Date: 12/14/2011

Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)

Route: Intramuscular (NCIT C28161, HL70162: IM)

Site: Left Thigh (HL7 LT)

The Following Vaccine Forecast is displayed:

Vaccine Group: Hep B Peds NOS

Due Date: 6/29/2015

Earliest Date to Give: 6/29/2015

Latest Date to Give: 7/29/2015

Overdue Date: 7/30/2015

Immunization Schedule: ACIP

Vaccine Group: Dtap

Due Date: 7/29/2015

Earliest Date to Give: 29-Jul-15

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: Hib

Due Date: 7/29/2015

Earliest Date to Give: 7/29/2015

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: IPV

Due Date: 7/29/2015

Earliest Date to Give: 7/29/2015

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: Pneumococcal conjugate

Due Date: 7/29/2015

Earliest Date to Give: 7/29/2015

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: Rotavirus

Due Date: 7/29/2015

Earliest Date to Give: 7/29/2015

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: Influenza

Due Date: Nov 26, 2015 or later

later

Earliest Date to Give: Nov 26, 2015

Latest Date to Give:

Overdue Date:

Immunization Schedule: ACIP

Vaccine Group: HepA

Due Date: 5/29/2016

Earliest Date to Give: 5/29/2016

Latest Date to Give: 5/29/2017

Overdue Date: 5/30/2017

Immunization Schedule: ACIP

Vaccine Group: MMR

Due Date: 5/29/2016

Earliest Date to Give: 5/29/2016

Latest Date to Give: 8/27/2016

Overdue Date: 8/28/2016

Immunization Schedule: ACIP

Vaccine Group: Varicella

Due Date: 5/29/2016

Earliest Date to Give: 5/29/2016

Latest Date to Give: 8/27/2016

Overdue Date: 8/28/2016

Immunization Schedule: ACIP

Notes to Testers

No Note

7. Cohort Report
This test will consist of generating a cohort report to list all patients who are overdue for immunizations showing all overdue immunizations with the associated due/overdue dates.
7.1. Overdue Immunizations
List all patients who are overdue for immunizations showing all overdue immunizations.
Test Story

Description

The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.

PostCondition

The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR.

Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.

Evaluation Criteria

The following patient information is provided on the cohort report:

Patient Name Mariela Gonzales Morales

Preferred Contact Method Phone

Contact information using preferred contact (email, text, phone, mailing address) (203) 555-1214

Patient Identifier Number Vendor Supplied

Patient Identifier Type Code    Vendor Supplied

Date/Time of Birth 5/30/2015 11am

Sex Female

Vaccine Group Hep B Peds NOS

Latest Date to Give 5/29/15

Overdue Date 5/29/15

Dose # 2

Dose in Series 3

Link to full record Vendor Supplied

Patient Name Juana Maria Gonzales Morales

Preferred Contact Method Phone

Contact information using preferred contact (email, text, phone, mailing address) (203) 555-1214

Patient Identifier Number Vendor Supplied

Patient Identifier Type Code Vendor Supplied

Date/Time of Birth 5/30/2015 11:15am

Sex Female

Vaccine Group Hep B Peds NOS

Latest Date to Give 5/29/15

Overdue Date 5/29/15

Dose # 2

Dose in Series 3

Link to full record Vendor Supplied

Notes to Testers

No Note

7.1.1. Produce Overdue Immunizations Cohort Report
Test Step Type:
The provider uses the EMR to create a report for all patient vaccinations overdue with the contact information.
Test Story

Description

The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.

PostCondition

The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR.

Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.

Evaluation Criteria

The following patient information is provided on the cohort report:

Patient Name   Mariela Gonzales Morales

Preferred Contact Method   Phone

Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214

Patient Identifier Number   Vendor Supplied

Patient Identifier Type Code      Vendor Supplied

Date/Time of Birth   3/30/2015 11am

Sex Female

Vaccine Group Hep B Peds NOS

Latest Date to Give 5/29/15

Overdue Date 5/29/15

Dose # 2

Dose in Series 3

Link to full record Vendor Supplied

Patient Name Juana Maria Gonzales Morales

Preferred Contact Method Phone

Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214

Patient Identifier Number   Vendor Supplied

Patient Identifier Type Code   Vendor Supplied

Date/Time of Birth   3/30/2015 11:15am

Sex   Female

Vaccine Group   Hep B Peds NOS

Latest Date to Give 5/29/15

Overdue Date   5/29/15

Dose #   2

Dose in Series   3

Link to full record   Vendor Supplied

Notes to Testers

No Note